My son does not exhibit symptoms at school, delaying diagnosis
My 10-year-old son is in the process of being diagnosed with bipolar disorder. I have known something is not right with him since he was about 15 m onths old.
My pregnancy was completely different than my first two (I have a 15-year-old boy and a 12-year-old girl). While I was overdue with the first 2, this one sent me into early labor and bed rest twice. He was born 2 1/2 weeks early, but initially healthy and not considered premature. Within hours after his birth, however, his body temperature dropped and his oxygen levels could not be regulated. Initially the pediatrician wanted to do a spinal tap to look for infection, but then he stabilized after being under the oxygen tent for 12 hours. He stayed in the hospital under oxygen for 5 days and we were sent home. We were told he had transitional tachypnea of the newborn (anyone else ever heard of this?), and that, in other words, he didn't transition well outside the womb--a sure sign of things to come, I believe.
Overall for the first year, he was a fairly easy infant, except for 2 things: unlike my older 2 children he did not sleep through the night until he was about 12 months (the other 2 slept through the night at 6 and 4 weeks, respectively). Secondly, he had severe reflux--he projectile vomited constantly (he was breast-fed for 22 months), but it did not seem to cause him any discomfort, so I did not modify my diet.
He "grew out" of the reflux/projectile vomiting around 15 months and then the tantrums started. He would wake up from a nap and be inconsolable for an hour. Nothing would make him happy. WHen he started biting himself, drawing blood and pulling out his hair during these tantrums I sought advice from my pediatrician, who suggested a psychologist to help me and his father cope. His tantrums were usually always associated with being told "no" to some request or activity, or trying to transition him from one activity to another.
He seemed to be delayed in his speech, which I believed was causing him a lot of frustration--I felt that he was so bright, but since he couldn't vocalize his thoughts it made him angry and severely frustrated. So I sought therapy and the social worker evaluated him for autism (negative) and then suggested sensory integration dysfunction. (He was obsessed with drinking coffee, taking a sip out of a beer bottle--he even ate my daughter's bowel movement!-and he was barely 2 years old) She gave me some occupational therapy ideas. He did receive some speech therapy, but was only about 3-6 months delayed in speech. Around this same time his tantrums escalated. I thought I just needed to be firmer, but it seemed the firmer I got the worse the tantrums and raging became. After one particularly bad episode I drove straight to a child services office and sought help. They referred me to the local school psychologist and he was given an IEP to attend a special education pre-school at the age of 3 1/2-4. He did very well there. He was the "head honcho" being that most of the students had cerebral palsy, Down's syndrome, autism, etc. The teacher (who herself had a prostethic leg) used my son to help the other children. He really seemed to flourish and enjoy the classroom ONCE HE WAS THERE. However getting him there was a nightmare. Separation anxiety was extremely severe. Usually the teacher/caregiver had to pull him off me with him screaming, kicking, crying etc. However, he never displayed the anger, frustration, tantrums, rages during school or with any other caregiver while in their care.
Then he started regular school and his IEP was closed. He did very well in Kindergarten through the end of 2nd grade. We had started seeing a psychologist prior to Kindergarten because of the tantruming issues and her advice seemed to help at times. Separation anxiety and getting him to school still very difficult.
Then it seems somewhat of a turning point: at the end of 2nd grade he and I got caught driving in a hailstorm. When we got home he had a full blown panic attack during the storm. After that the night terrors started (sleeping had never been great). It was like having a newborn again. Then what I called tantrums escalated to horrible raging, including damaging furniture, throwing things and threatening harm to himself ( he once held a knife to his own throat). I would have to sit on him or tie him to a chair to prevent him from destroying things or harming himself or the dog. Occasionally he would go after his sister, but usually directed this at me. He would also not let me out of his sight. I at first thought he was afraid for himself. Then I found out he was afraid of something happening to me. He hated to go anywhere that involved driving on a freeway or being away from me for any length of time. He would follow me outside at 11:00 pm at night (when he should have been in bed) to make sure nothing happened to me while I was walking the dog. If there were clouds in the sky he wouldn't step foot out of the house. Oppositional and defiant attitudes and behavior went off the chart. Almost everything we asked of him was met with "No!" and then a tantrum, argument, anger.
After the raging would end we would try to teach and reason with him, but he didn't seem to have much memory of what had just transpired. He was usually sad, remoreseful and self loathing. Many times he would say he hated himself. If he wasn't saying that, he was saying "I'm bored" constantly even though he had a new activity/toy to work with and being offered to engage in some type of game or casual play with myself or his father.
We tried charts, reward systems, grounding everything you can think of: prayer, meditation, reasoning--nothing seems to change the behavior. We are truly puzzled,not to mention frustrated, angered and scared about why he can't seem to learn behaviorally. All this time seeing a very good child psychologist who has been very helpful. We were referred to a psychiatrist who prescribed citalopram starting at 5 mg/day and has increased to 20 mg/day to deal with the extreme anxiety. This has helped with the sleeping issues, but it has not helped with the explosive, agitated, or oppositional behavior.
Now here's the curious thing: none of these behaviors appear (from what the teachers have told me) to be exhibited in school. They see some ADHD-like behaviors, but they are always 1s and 2s on the questionnaires, never clinically significant. Also, for awhile the tantrums were only happening between 5-7 pm--what we started calling the "bewitching hour."
Finally the psychologist has suggested that he has bipolar disorder. After reading about 1/3 of The Bipolar Child by Papolos I am thoroughly convinced. The Very Common behavioral traits listed on page 51 of this book are like reading a dossier on my son. He has almost every one to a degree that is making our lives miserable. We are cancelling vacations, we don't make the kinds of plans socially we used to and I know friends have been alienated due to his condition. I have made an appt with a local clinic that specializes in early-onset bpd.
My question is -- has anyone else experienced these symptoms only in the home environment? We have seen tantrums in public, but not in school. I am afraid this will hinder the diagnosis and the help I believe my child needs.
There is more to this story--he can be brilliant at times. After one raging episode, he gave a presentation to an adult audience that was spot-on perfect--he sounded like he was 20 yrs old, not 10!
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Jacqueline Werner
Absolutely, we have stories similar to yours, from the not sleeping in infancy and gastrointestinal problems to the not showing it at school. My younger daughter talked about why (in book). She knew how the other kids attacked kids who were different. She held in a lot of emotion, then would just go berserk as soon as she was out and could relax. Even in the psychiatric hospital they called her "good" when what they were seeing was a child who was scared and just withdrawing - bottling everything up. It did not delay diagnosis because the diagnosis was based on other things - depression, and hypomania, paranoia, screaming spells and finally hallucinations.
The actual diagnosis was not as important as treatment.
--"Naomi"
It's Not Mental
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added EMpowerPlus back on just because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.
Thank you for your input. One thing that is not obvious in my son is the depression--he's never seemed to have that, although I do wonder if his constant use of the phrase "I'm bored" could be a manifestation of it.
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Jacqueline Werner
Was just talking to my son's pdoc yesterday about the 'holding it together at school' issue. He completely confirms that this is common and said that he even sees that with kids with Tourette's syndrome which is very neurological...but apparently there is some ability to control symtoms thorugh sheer willpower, for finite periods of time, when the person would be embarrassed by the symptom. When they come home to a safe zone though, then they are even more likely to have severe symptoms from all of that stress during the school day.
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Chris Stanley- DS 10, ADHD, ODD, mood disorder NOS
currently taking Adderall XR, Abilify, Risperidone, Trileptal, Melatonin
Chris,
Yep. You are absolutely right in the comparison (imo). You can see in my signature line, the younger daughter also had mild Tourette's (TS). Once she understood what her tics were (that they were tics) she started modifying them, and pacing their release so as not to embarrass herself. Some she could not help, but others she could semi-control. I felt so sad because think of the energy they use just holding things back all day, and trying to pace themselves and protect themselves.
I often compared her after-school fits the same as the Tourette's and releasing her tics.
--"Naomi"
It's Not Mental
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added EMpowerPlus back on just because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.
My daughter is the same way! Her current teacher refers to her as the ''model student''...which is both wonderful & extremely frustrating at the same time. I am thrilled she's doing well in school but am so frustrated &, like you, worried it will hinder the dx process. She typically completely melts down as soon as we get to the car after school...sometimes as soon as she's out of the building. I 100% believe she is holding it all in until she is back with me & in her ''safe zone''. I'm now accustomed to after school ''beatings'' of rage as she releases it all...she is always very irritable after a school day. Apparently it is quite common though b/c I've had several parents of BP kids state their LO's act the same.
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~*~Lisa*aka*Mommy~*~
DD(7)-asthma, allergies (dust mite, tree pollen, severe cat/dog, animal dander, some metals)
DD(6)-ADHD, ADD, ODD, GAD, severe OCD, mild verbal apraxia, ''borderline'' ASD, possible BPD
DS(4)-preemie, chronic asthma, severe SPD, development/speech delays (almost caught up thanks to 2+ yrs of extensive therapy!)
I have read this same basic story many times on these forums. I think it is almost the norm for our kids to usually behave at school and then fall apart at home. If they start showing their sx at school, then you know things are really bad.
Have you read Ross Greene's "The Explosive Child"? He has techniques for avoiding or minimizing meltdowns. The best way is to avoid triggers. Some parents get around the "no" word by offering choices. Something about "no" just is guaranteed to set off a rage in an unstable child.
Here is a link to the Expert Treatment Guidelines. I highly recommend reading through this, and also printing it out. That way you can take it with you to pdoc appts. to go over possible treatment options. You may also want to have him evaluated for sensory integration issues. Sensory sensitivities can sometimes be difficult to see, but once identified can be addressed to help prevent some meltdowns.
His anxiety could be related to depression. Certainly taking a knife to his throat is a sign that he is not feeling good about life. Depression can show up with anger and irritability as well as irrational fears. Has he had neuro-psych testing done? Here is an article from The Bipolar Child on boredom and its relation to pediatric BP.
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Brenda,51, TBMF Parent to Parent Volunteer
Mom to A, 17, BP, Tourette's, OCD, ADHD: Eskalith CR, Trilafon, Lamictal, Seroquel, Cytomel, Allegra
E, 15 1/2, BP,AS: Seroquel, Eskalith CR, inositol, Buspar
B, 14 & H, 11
Married 18 years to DH, 50
FROM TBMF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.
Thank you, Brenda H. I have read the Explosive Child--I own the book, but leant it to a friend and unfortunately have not gotten it back yet. I'm sure it would be a helpful reread to refresh my memory on strategies to help.
He has not had neuro-psych testing--what is involved with that? I've been the one to fill out all the forms and questionnaires so far.
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Jacqueline Werner
Also, to the others, thank you for that confirmation re: school and holding it in. While our psychologist has explained this to me and I agree with the reasoning the psychiatrist we are seeing is adamant about not making a diagnosis of anything without seeing symptoms in 2 settings. I've tried to explain to him what our psychologist says, to no avail. Hence, we have an appt next week with a new psychiatrist who specializes in early-onset bpd.
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Jacqueline Werner
We are going through the same thing. My dd can hold it together at school then unleashes the rage once home. We are in search of a psychiatrist and are finding there are few out there. We have an appt with a mental health therapist at the end of the month, but that seems so far away. I wish you the best!!!
Neuro-psych testing will involve filling out lots of surveys of behaviors you observe. But it also involves a psychologist (usually) talking with your child and doing certain tests/activities to assess the child's level of functioning and behavioral responses. They evaluate for mood disorders, anxiety disorders, ASD's, ADD/ADHD, psychosis.
Great news about getting in with a new pdoc next week who understands pediatric BP. Be sure to let us know how that goes.
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Brenda,51, TBMF Parent to Parent Volunteer
Mom to A, 17, BP, Tourette's, OCD, ADHD: Eskalith CR, Trilafon, Lamictal, Seroquel, Cytomel, Allegra
E, 15 1/2, BP,AS: Seroquel, Eskalith CR, inositol, Buspar
B, 14 & H, 11
Married 18 years to DH, 50
FROM TBMF: Do not start, stop, or change medications or other treatments for yourself or your child based on what you read on this Website or elsewhere on the Internet. Information presented here should not replace the considered judgement of a doctor who knows you or your child.
Well, then, yes he has had that. We have been seeing a psychologist for about 5 years, off and on. He has had evaluations by her, as well as the school psychologist.
I will let you know how the appt. goes. We are very fortunate to live in an area that has many medical teaching institutions and two major, world-renowned healthcare systems.
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Jacqueline Werner
One other question: since my son has not been officially diagnosed yet, there is something that is bothering me. The Bipolar Child states that over 80% of children taking an antidepressant who have bpd will experience some sort of psychosis. My son has been on Celexa for over a year due to his extreme anxiety (generalized and separation) and it has seemed to help with the anxiety and he is certainly sleeping much better. There has only been one time a few months after he started the Celexa that he described hearing voices. Other than that, nothing that I'm aware of. Anyone else know of a child taking antidepressants who had bpd and has NOT experienced psychosis?
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Jacqueline Werner
My son was diagnosed with BPII at the end of August. However, he has had behavioral issues since he was a toddler so he has a long history with medication. He was on Prozac from about 6 1/2 yrs old until almost 13 yrs old with only a couple of breaks. He never had an episode of psychosis. He was placed on Prozac again after his suicide attempt in April. The Prozac caused him to start rapid cycling between mild depression and severe depression but he did not have psychosis. Once his depression improved the Prozac would cause him to rapid cycle between mild depression and hypomania so he was tapered off of it.
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Beth
DH - Husband & Father
DS 16.4 - BP II, NVLD, GAD, Borderline Personality Traits, Transgender (female to male) and gifted
Geodon 40mg AM/PM (tapering off), Buspar 15mg AM/PM & Lunesta 2mg PM
In 11th grade at a small alternative hybrid competency based public high school in Northern California, with IEP for ED & SLD
My son took Zoloft (while on Abilify) a little over a year ago and after 10 days was clearly manic. This was the first true manic episode he had had. After that we tried Lamictal which has helped a lot. This summer we weaned him off of Abilify. Once that was out of his system and following an independent neuro-pshyc eval which diagnosed disthymia (chronic depression) and social phobia, we tried the AD again with the idea that the base med is different this time around, Lamictal now vs Abilify then. It has been better this time. Right now I am seeing a more clear mild cycle happening, which while not the best it is better than the manic episode he had before. Also, the pdoc said this is probably the lowest dose of Prozac he has ever prescribed.
I think all kids have different reactions to the same types of meds. I have been able to see a different reaction from my son with the same class of mesd and two different base meds. I try to keep in mind that even if a med works now or has in the past that as my son grows and matures, his chemistry changes and therefor the effects of the meds may change too.
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Betsy
Adam - son - 10 yrs old - Mood Disorder NOS R/O Bipolar - 200 mg Lamictal, 2 mg Guanfacine, 10 mg Prozac
5th grade public school with IEP for Speach, LD, and EBD
Daughter - 18 - College freshman
Husband - doing MUCH better with Adam
Sun Prairie, Wisconsin
Thanks, Betsy. I agree re: different ways meds affect different kids.
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Jacqueline Werner
My son does the same- he actually verbalized it to me this week- he said "I never act that way at school, it is too embarassing". . . He's very sensitive to being embarassed and never shows his rages at school or with other people around, only at home with his immediate family. . . all I could thinks was "lucky me" . . . I am glad however, that he does not show this at school- he has enough socialization problems without adding bizzare rages into to the mix . . .
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St Louis, Missouri
Arret (Mom) 40
Depression- Sertaline 100mg, Levothyroxine 112 mcg (thyroid)
Al (Dad) 39
ADHD- no meds
Kit (Christopher) 10
BP, ADHD, Asthma, Growth Hormone Deficiency - Concerta ER 72mg, Risperdal 1.5 mg at bedtime, Clonidine .1mg, Singular 5mg, Humatrope injection at bedtime
Katie (Kaitlyn) 8
Socialite
Coco- 1 1/2 yr Cocker Spaniel- Hyper
Smokey 1 yr Papillon - Rescue dog- working on his trust issues
Arret (Terralc) - I noticed your son is on Humatrope. My younger daughter is on it, too (switched from Genotropin because insurance forced it). Her symptoms improved with the addition of that and some other hormones. I am wondering... if you don't mind saying... is it hypothalamic, idiopathic pituitary, or some known cause? A lot of that daughter's issues are now just lumped under hypothalamic dysfunction (unspecified cause).
--"Naomi"
It's Not Mental
Older dd: formerly(?) teen-onset bipolar (morphed into ultradian cycling): "Recovered" after over 13 years - stable off psych meds almost two years. Now fine on just diet changes and higher thyroid levels (after healing - addressing gut issues/Candidal overgrowth while using EMPowerPlus and other supplements). She added EMpowerPlus back on just because she feels better on it - gets sick less often.
Younger dd: formerly(?) Childhood-onset schizoaffective, TS, OCD, anxiety, PTSD, migraines. After over 15 years, is now "recovered" for almost 5 years after treating endocrine issues, food sensitivities, gut issues, sleep issues, nutritional/mitochondrial needs.