You be the psychiatrist

[FlipFlops]

I've taken off difficult child's diagnosis from my signature and want to know what you all would diagnosis. I am fully aware you are not docs and not "qualified" to make a diagnosis. But, you all have lived it or know a bit about it. I'm going to give the lengthy, cliff notes. What does it sound like to you?

Pregnancy:
Left bio father at 3 mos pregnant because he had been physically abusive in the past and looked like it might be going that way again. Bio father and I were living with his relatives at time but had met in another state. Lived with them about 4 months at that time, during which I was finding out he had lied about almost every detail of his life. Stupid, insignificant stuff to lie about too. He went to work, I packed a bag and went to my home state. Last I saw of him.
Rest of preg went fine. No problems. Full term. Perfect delivery, except I pop 'em out too fast to get medications! Ouch...

Early Childhood:
Maybe a little fussy. Being a single mom with no child support and nothing to my name, I had several babysitters until about 1 1/2 yrs. They may or may not have been the best people. Don't know. At about 2 he was almost kicked out of daycare for biting. Everyone said bite him back, so I did. Didn't work. Daycare owner had compassion for me and did not kick him out. Also moved about 6 times before he was 3.
husband and I met when difficult child was 7 months and have been together ever since. Married when difficult child was 2 I think.
At around 3 yrs we noticed he was a little quirky. In the morning we would often be woke up by difficult child standing next to the bed, sippy cup in hand, yelling,"MILK!!". He would also wake up early and raid the kitchen. We installed doors on the kitchen and put a kid lock, it was that much of an issue. Didn't stop him. One morning he climbed through the bar window, got a whole box of chocolates, unwrapped them all, and lined them up like a train in the living room floor.
At 4 yrs I put him in pre-k. I was figuring some adhd or something. Teacher thought it was a maybe.

Kindergarten:
3rd day of kinder in the principal's office. The next week suspended for hitting. One disaster after another. He was suspended at least 30 times, and countless writeups. Mostly hitting staff members, hit kids a few times, and hit a volunteer mom once too. Tried different teachers. By october seeing a psychiatrist. Received a diagnosis and medications. No change. Moved to a resource class and towards end of year, into an adaptive behavior class on another campus. His behavior was just as bad at home too.

1st grade:
New Adap Behav class on new campus. Teacher was horrible. Suspensions. Leaving the building. Miserable all around. I think we were also doing play therapy by this time also. Got tired of all the suspensions and being in trouble all the time. I just withdrew him and was going to homeschool. There was still all the physical aggression at home too. By april or may my regular doctor said I needed to put him back in school, and soon, because it was taking a visible, physical toll on me. I was looking rough... Put him back in school.

2nd/1st grade:
3rd Adap Behav class and campus. GREAT teacher. We had him reclassified as 1st grade again. Said it was because he missed most of first, but was really because he had been barely 5 when started originally and thought maybe he needed another year. Things weren't any better. We had already switched medications a few times too. Physical aggression was getting worse. Bit Asst Principal on arm and broke the skin. As well as lots of other things. Put him psychiatric hospital. Most stay about 3-5 days, he stayed 19. Even up to the day we picked him up they were still shooting him up with thorazine to control him. Went back two more times that year or the next. 3 total visits to the psychiatric hospital. All visits were because of out of control violent behavior at home. Close to end of year he was placed at a therapuetic campus in our school dist. More medications, no change.

3rd grade:
Still at therapuetic school. Made some improvements at school and earned a chance to go back to a regular campus into an AB class. Didn't last. Distict police called more than once and eventually went back to therap school. More medications. More violence at home. 3-4 broken windows at home. Threw brick through neighbors window. Gave a cop a black eye. Hitting, kicking, pinching, biting. Threw a golfball at me, hit my brow leaving me with a cut and later a black eye. He weighs about 20 pounds less than me at this time and is 900-1200 mg seroquel daily.

4th grade:
Same type of stuff, but has now started trying to choke me. Went to juvie in October, November (a really AWFUL episode for me!!) and May all for assault to me. Should have gone in April, but DA rejected charges because he is mentally ill.

Sorry so long, almost done. Lieing, stealing, destruction of property, physical aggression, hitting, kicking, biting, hair pulling(literally yanks me around by my hair), pinching, no fear of authority (except the cops at juvie) takes no responsibiltiy, always someone else's fault... From Oct 03 to May 09 he has been on close to 15 different medications with no change in behavior. Just gets bigger and stronger. No academic problems. Too smart for his own good. Asks about a million questions a day, even stuff he knows the answer to or has asked before. No cruelty to animals. No fires. Easily angered or frustrated. Throws controllers when mad about video games...Any questions?

So what's his diagnosis? And if you read all this, thank you so much. You are a dedicated person and exactly who I want to hear from. I don't think his diagnosis is accurate, and never did. Thank you again for reading all this.

 

[BusynMember]

My layman's opinion: Take him to a neuropsychologist. I suspect high functioning autism, which is going untreated which is creating frustration and violence and being misunderstood as willful defiance. MANY big red flags for autistic spectrum disorder, which medications usually don't help. That requires interventions. It is a neurological difference, not a mental illness, although it can look like one so be careful. A psychiatrist could easily miss it. JMO

 

[ML]

My uneducated opinion is the same as MWM and also agree that you should get him completely evaluated again. I know how frustrating it is to not have a diagnosis that feels right. Hugs, ML

 

[totoro]

What about family history?
I agree with the Nuero-psychiatric evaluation. But if it is not a good one that can be a wash as well.

Was it a psychiatrist prescribing the medications? It sounds like it was. The only reason I ask is because K was put through a ton of medications by a very incompetent psychiatrist almost 2 years ago now. She was also Hospitalized semi-partially (long story) for 5 weeks. But during this time the psychiatrist had her on and off of so many medications that there was no way they were going to help.
If I didn't keep trudging forward I may have questioned her diagnosis and if I had not left this guy, K would have been truly lost.

The thing is is that with BiPolar (BP) and young kids, it is very hard because you have growth, hormones, changing of the actual illness, instability (seasonal etc.)
Let alone just trying to figure out what medication even works for this particular child.

I am not saying he has BiPolar (BP) or not. But most of our kids have at one time or another looked alike or reacted alike at certain times in their lives, so it is a tough call with out lengthy testing or spending time with him.
K's sensory issues mimic many Autism Spectrum symptoms as well as her NonVerbal Learning Disorder (NVLD). She can look like a lot of different things at different times.


I hope you find the answers soon for you and him. He deserves a diagnosis and the treatment to help him. Whether it is Autism, ADHD, ODD etc...

 

[FlipFlops]

Are there particular evaluations I should ask for? We recently started neurofeedback therapy and had brain mapping done and a urine analysis. I could not explain what they said about the mapping. There were a couple of spots in his brain that they said were overactive. The urine analysis said there were a bunch (Epinenephrine, Norepinephrine.....) things that were elevated and amino acid therapy was suggested. Calm-prt jr, kavinace, endotrex and some other things were suggested. I faxed this to our regular MD today asking his opinion. I want his opinion because he is very knowledgable about things and would tell me if it was a "scam" or would actually tell me if it was out of his league.
Thank you for your replies. It really makes me feel good that people took the time to read all that in the first place and then to offer their opinion.

 

[flutterby]

I was thinking Autism Spectrum Disorders (ASD) from your other posts, as well.

Do you notice any triggers that set him off? Overstimulation? Noise, light, texture, food sensitivities?

Cause I tell you what, since I've gotten ill I have become very sensitive to noise (among other things) and when there is too much going on I am NOT pleasant to be around. I can't filter it. It's sensory overload. The difference is I'm older and I know what it used to be like to not feel that way. I still can't control it, though. I have to take a klonopin if I can't get away from it or I go off on people (not physically). Several of us are going on a picnic tomorrow and while I'm looking forward to it, I know it's going to be too much. I've already packed a blanket so I can go off by myself somewhere.

 

[FlipFlops]

What sets him off more than anything is "no". Almost everything he flips about has to do with what he wants and not getting it. A consequence being enforced. The last episode with me was because he had to stay in his room. I knew it was going to go south, and my little one was in the next room so kept difficult child in his room. And once it was on, I really couldn't let him out because I would then risk damage to other things in the house, others in the house, or leaving the house and damaging other people's property. I know this from past experience. You can't just ignore the bad behavior sometimes. It doesn't happen every time, but I would rather all those other details be safe than sorry. And if I were to just overlook everything and not make him stay in his room, then I am inconsistent. I live in a no win situation. If you back down because you think you are about to get your booty beat, you are told you are inconsistent. If you stand your ground, you get told pick your battles better. I told the therapist the other day that he keeps passing gas in my bedroom on purpose to annoy me. She asked me why I don't just leave the room. because its MY bedroom. Can't I have one place in the house that is MINE?
He also gets upset if he is being picked on or thinks he is. That would go with the Autism stuff. His answer, and he has said this, is to physically shut them up pretty much. He also annoys or amusement. He's bored so he starts messing with everyone. If you try to remove yourself from him, he will follow you and keep doing it.
I'm think crowds can be overstimulating. But we have avoided those for a long time. Last summer at a water park he started fighting with some kid and parents got involved. We were expecting him back to our table in about ten or so minutes. After awhile I asked a security guy to help me find my difficult child. He asked are you so and so. I knew then they had him. Sure enough. He was cuffed in the medic area.
I know I avoid crowds like the plague if we have difficult child, unless it is something I REALLY want to do. I get very overstimulated, more so now than ever. Poor easy child 2, I think the last real b-day party he had was when he was 1 or 2. Now we just go as a family to do something. I can't wait for difficult child to go to camp so I can have a slumber party and make a fort out of the couch cushions for easy child 2. He has no life. Kids can't come over here. difficult child makes it miserable. While difficult child was in juvie this last time husband and I got to take easy child 1 to her first concert and it was one of my fave bands. He was gone 26 days and I'm a little ashamed to say, I never missed him once. Life was so much easier...

 

[mamabear01]

I also agree with the Autism Spectrum Disorders (ASD). Boy the lining things up and sleep problems brought me to attention.

I would go to a NP who has experience with Autism Spectrum Disorders (ASD) BECAUSE, they are experienced with all of the co-mobids that Autism Spectrum Disorders (ASD) includes.

For example, Autism Spectrum Disorders (ASD) is a cluster of things.... ADHD, Obsessive Compulsive Disorder (OCD), Anxiety, Sensory, Mood Disorders, Learning Disorders, ect..... So if your child doesn't have Autism Spectrum Disorders (ASD), then the doctor can sit back and say well I see the ADHD, but I don't see the Obsessive Compulsive Disorder (OCD), or the Sensory. It's only ADHD.

Or since they are experienced with all of the co-morbids and see it all, they can wrap it up in one package.

When I was looking for a therapist to help my kids I had choices like doctors who were specialized in PTSD, Obsessive Compulsive Disorder (OCD), and ADHD ect. I didn't want them. I wanted someone who was well rounded with ALL of the co-morbids so they could understand my children with the whole picture idea.

I was right.

 

[mamabear01]

Purple, except for the juvie stuff, you have basically described my two boys.

I also want to add, walking out of the room works really well. My boys will get too hyper and start bugging each other to no end and it ends up being over the top and escalates. My husband and I decided after awhile that we would walk out of the room and I have to say after awhile it started working.

I was surprised how well it worked, but by golly it did. Plus it helped my sanity. I went downstairs all alone and watched what I wanted too on the TV lol. It gave me time to re-group and calm down.

I also used to lock myself in the bathroom too for my own time out lol. That helped too hehehehe.

 

[BusynMember]

Take him for a neuropsychologist evaluation. I don't believe your child has ODD and maybe not even bipolar, although I don't know that (my son was misdiagnosed with bipolar and put on a slew of medications).

A neuropsychologist will do 6-10 hours of testing which psychiatrists don't do. The lining things up is so classic for autism. And these kids can NOT transition well from one activity to another so if you try to interrupt what they are doing, mayhem can take place. You have to learn how to parent them. And they need interventionis (not therapy or tons of medications) to learn how to deal with a world that they don't understand. I have a son on the spectrum who was misdiagnosed a ton of times, but once he got the right diagnosis. he totally turned around. He's a great kid now with lots of potential, although he is still different. We all understand him now.

in my opinion your psychiatrists are on the wrong track. Take him to a neuropsychologist without telling the neuropsychologist all the other diagnoses and see what he finds. My own opinion is that Autism Spectrum Disorders (ASD) is often overlooked and tagged with ADHD/bipolar. Since bipolar has been found to exist in kids, my own layman's opinion (which you asked for) is that it's been grossly overdiagnosed whenever a child acts out, and that many psychiatrists fail to look at other disorders, especially when there is inflexibility, sensory issues, and high anxiety (out of the roof anxiety). And then, of course, they pull out the prescription pad and start with the medications before doing any tests at all. I don't like that. I've seen psychiatrists since I've been 23 (I'm 55) and I really DO have a mood disorder. There are many psychiatrists I've been to that I instinctively knew were just plain BAD.

Schedule a neuropsychologist evaluation and see what is found. Good luck! (We all need that!)

 

[Marguerite]

At the risk of repeating what you may have been told in previous posts/threads -

1) For the ODD type of stuff, read "The Explosive Child" by Ross Greene. It can help you find a different way of looking at him, to find a way around the "No!" problem. No method is perfect, if whatever you're trying isn't working then you need to not bother with it, look around for something else which MAY work (you don't know until you at least run it through in your head).

2) The "unofficial diagnosis" you want from us all - sounds like so far there is a lot of consensus on Pervasive Developmental Disorder (PDD) in some form, especially high-functioning autism or Asperger's. Of course we can't diagnose that. Even if we were qualified, you would need to examine the boy in person, take a detailed history from you on his early development history in much more detail than you gave us, plus do some detailed testing, look at reports from schools etc and then put all the puzzle pieces together.

3) But there is more that you can do for yourself, to speed up the process mentioned in the above point. The quickest thing you can do NOW, is go to www.childbrain.com and loook for their Pervasive Developmental Disorder (PDD) questionnaire. It also cannot be used to diagnose but YOU can use it to give you a 'feel' for the sort of things you need to understand baout him. You can even ask it to score for you, to see (unofficially) how likely a Pervasive Developmental Disorder (PDD) diagnosis could be. Print out the results and take them to a specialist. It will at least show the areas of concern for you. Keep a copy in your files, to refer back to in years to come.

4) Something that can help in terms of good communication with school, plus some fast response to problems, is to bring in a "Communication Book". It travels to and from school in difficult child's bag. It should NEVER be difficult child's responsibility to hand it over to anyone, teachers should get it from his bag at school and put it back when they're done with it. Similarly at home, YOU get it form his bag and put it back in.
The book is used to pass notes back and forth. You might write, "He slept badly last night, he's begun wetting the bed again." The teacher might reply with, "He did moderately well thismorning, he completed his worksheets. However, I noticed he was very agitated after the lunch break. I wonder if there is something going on in the playground."
The Book can hep either teachers or parents see behaviour patterns BEFORE they would otherwise become obvious. If there is a problem developing (such as a sudden increase in anxiety, perhaps due to bullying) then the Book helps find this fastest. The sooner you can put a stop to a problem, the less long-term hassles from it. And vice versa. It really helps, but you need to have it in the IEP and make sure they follow it.

Your son may turn out to have something other than what has already been suggested. A neuropsychologist appointment is something to aim for, to give you some definitive and useful answers. With a diagnosis, support doors can open. Without it, hands are tied (or sat on) and everyone gets frustrated. You, the child, teachers - anyone who has to work with him.

The sooner you know, the sooner you can help him as effectively as possible.

Marg

 

[therese005us]

Hi,

when I started reading your post, I immediately thought Reactive Attachment Disorder (RAD), and I still think it's a possibility. Also, I agree with the Autism Spectrum Disorders (ASD) suggestions and ODD.
I can't add anymore sensible ideas to what has already been suggested, so i would like to send lots of hugs and thoughts your way while you are dealing with 'starting again' with a diagnosis. It is always a long road to finding just the right 'mix' to help our children, but you will find it.
Good luck, and God bless

 

[lovemysons]

PJ, I sure hope you find out whats really goin on with difficult child.

Hugs,
Tammy

 

[AnnieO]

I would say I second the possibility of an Autism Spectrum Disorders (ASD) but I'm like the 14th or 15th post. Take him to a neuropsychologist and have him assessed. I bet the ADHD drugs make him worse, not better. This is what happened with difficult child 2. Basically a loving, sweet boy in his own world. Give him a stimulant and then run for cover.

A lot of kids with an Autism Spectrum Disorders (ASD) are misdiagnosed with ADHD first. Now I'm not saying it's not ADHD. But I'm betting on more or something different.

{{{{{HUGS}}}}}

 

[FlipFlops]

difficult child was diagnosis bipolar and adhd at 5. I have had enough people chime in with their opinions, and practical experience, that I think we have a concesus. I had really thought ODD was the more accurate diagnosis but you guys had me look at a different alternative. Thanks. I really had not anticipated that. husband has long said autism. In fact he tells people sometimes that difficult child is autistic, just makes it easier. It seems like the general public can get their head around that easier than bipolar and adhd. Everyone knows a kid with adhd, and none of them act like our difficult child.
Thank you all soooo much for taking the time to respond and read my book. I really really appreciate it.

 

[Steely]

Just want to jump in here and say I agree with the others in getting him tested.
Your bio describes my son to the tee - and he has a Non Verbal Learning Disorder. A NonVerbal Learning Disorder (NVLD) is close to Aspergers, but not quite.
I would get him fully tested (which takes a full 12 hours or so) in order to get the proper diagnosis.
My son also has Bi-Polar which could also be true of your son. However - the only true way to diagnosis Bi-Polar is time. No one can actually tell if a child at the age of 5 is Bi-Polar. It takes consistent, pervasive behavior over a period of time to identify Bi-Polar.

 

[trinityroyal]

Purple, I agree with everything that the other posters have said, especially about getting a full neuropsychologist workup done by someone who has a good understanding of Autism Spectrum Disorders (ASD).

Now my $0.02...

From your descriptions, I agree with the others about the strong possibility of Autism Spectrum Disorders (ASD). But it seems that there's more going on than that. It's possible that, like my difficult child, yours is BOTH Autism Spectrum Disorders (ASD) AND Bipolar, which can complicate matters terribly.

We found over the years that the specialists focused on the one disorder, in our case the Autism Spectrum Disorders (ASD), at the expense of the other.

Hopeyou find the answers.

Trinity