Possible Bipolar in Almost 4 Y/O?
I'm new here but I have an almost 4 year old (will be 4 next month) that we've been having serious concerns about for about the past 9 months to almost a year. Initially, we thought it was due to his younger brother's multiple hospitalizations (former preemie and gobs of ongoing medical issues - he'll be 2 in March) and him being the middle child. We tried every parenting technique and suggestion thrown at us to get his behavior "under control." In addition, I almost have a master's in social work with a background in both the mental health and child welfare fields. But this past fall, things REALLY began to spiral further out of control. His outbursts were very frequent (at least daily) and violent. Hitting, kicking, biting, screaming, you name it. Then he threatened to kill his younger brother and tried to stab me with scissors. At that point, we had him admitted to an inpatient psychiatric facility for children. Typically, they keep kids 7-9 days but they kept him for 2 and said he was just having trouble adjusting to his brother's disabilities. He was PERFECT while he was there, even though he had to be restrained by staff while we were filling out paperwork and doing the intake process because he was getting violent with me and DH. Anyway, he was discharged without meds and we were told to follow up with a counselor, be consistent with discipline (DUH, we were already doing), and to spend more one on one time with him.
Now, 5 months later, we have been doing all those things but he is worse now than ever. He continues to threaten to kill us and is violent with everyone. He punched and kicked his sunday school teacher at church and told someone else he was going to burn the church down (we just go to a small country church). He will get angry and tackle his OLDER brother to the ground and just start punching or kicking him in the stomach and LAUGH when Avery cries. He is about to get kicked out of Preschool for equally violent behavior there - biting other kids when they don't give him something, screaming, threatening, etc. The school has been getting complaints from other students' parents, as well.
At home, he tells me every single day that he hates me. Threatens to kill us, has tried multiple times to stab with scissors, pencils, etc. Throws toys, hurts his older brother. When he goes into one of his rages, we calmly pick him up and put him in his room (which has no door) and tell him he can come out whenever he's done being so angry. He will sit in there and scream so angrily and pick toys and stuff up and throw them against the wall (I'm waiting for a window to get broken in one of these rages because sooner or later it's going to happen); he will stomp his toys, too. It's really very scary but I don't feel like the inpatient hospitalization did ANYTHING for him and worry about him picking up behaviors from older kids so I don't want to go that route.
I recently took him to our pediatrician who referred to a child psychiatrist. We went to that appointment and he said he thinks he has an emerging bipolar disorder but that he can't prescribe any mood stabilizers because of insurance, even though he feels that's what Xander needs. He said he has to try ADHD medications, first. So, he prescribed Tenex (which is a non-stimulant ADHD medication), which I'm already familiar with because Avery is on it for ADHD. We started the Tenex a week ago. For the first 5 days, he was great on it and we had better days than he's EVER had. But, yesterday, he is back to raging, again. I think the only reason he did well on it the first 5 days was because it made him tired so he was getting used to it. Last night, he was up til 1 AM again, despite me giving him 10 mg of Melatonin...he doesn't sleep well at all.
Family history - there is serious history of mental illness in my family. 2 of my sisters and my brother and uncle and grandmother all have bi-polar disorder. My father and grandfather (and in all likelihood one of my sisters) have schizophrenia. DH had ADHD as a child and learning disabilities in Reading/English (gifted in math/computers/science - first kid in our school system to be both in special education AND gifted classes at the same time). I suffer from depression from time to time (take medication when it gets really bad).
I feel bad for Xander and like a horrible parent at the same time. I've tried to do everything I can to make sure my kids have a much better childhood than I had (mentally ill parents with polysubstance abuse issues; abusive, you name it) but now this. Other people don't understand and just tell me I need to get him "under control." I don't know what to do. We go see the psychiatrist again in another month and I'm trying to get him into a counselor. Oh...that brings me to another issue - we were told by the hospital to get him into counseling. But when I called, no one would take him, saying medicaid won't pay for kids under 4 (we have medicaid because I have to stay home because our youngest is in the hospital so frequently that I lost my state job because of it and no employer is going to let me be gone as much as I'd have to be with all the hospitalizations and specialist appointments he has and we're 3 hours away from the children's hospital he goes to). Anyway, I recently found a counselor that CAN take medicaid for kids under 4. He is 1 1/2 hours away but I'm going to take him there, weekly, anyway...if it'll help I'll drive him to the moon every week.
If you followed that....has anyone else had a LO with issues SOOO young? I hated giving into putting him on medication so young. I have always been of the mindset that bipolar shouldn't be diagnosed to young and that mental illness in young children is rare. Don't flame me for that - that's what I've been taught in school and professionally...so it never even crossed my mind that I'd be in the boat of having to medicate my child - for our and HIS safety.
Sorry so long...just a lot of info and no one to turn to about this. Oh, and I am going to ask the doctor or psychiatrist about getting him an EEG to check for silent seizures since my youngest son has epilepsy.
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Desirée
Mom to Avery (5/2006) - ADHD/Tenex 1 mg in AM, 0.5 mg in PM
Xander (2/2008) - possible Bipolar; Tenex 0.5 mg 2x/day started 1/20/12, Melatonin 10 mg
Liam (3/2010) - former 28-weekr/multiple disabilities/medical issues, Global Developmental Delays, Epilepsy, Autonomic Dysfunction; 22 post-NICU hospitalizations
Desiree,
Welcome to this web site. You will find everybody here who has dealt with very difficult mentally ill children. Everyones case is unique, but we all cringe when we read a post like yours because we have been in a similar situation. You almost describe our daughter at that age perfectly.
Our daughter was on Intuniv this past summer. While it started out good, It was really was the wrong medicine. See several posts on this site about Intuniv and Tenex. Some people do okay, but there are a lot of negative opinions about it.
I would encourage you to do everything you can to run down medical causes. The EEG would be a good thing. So would an evaluation of hormone levels. Something may be causing the sleep disurbance.
Something to think about is a look at nutrition and supplements. There is a lot of information on the CAM section of this forum. At one time, I read all the archived posts. A books by a lady active on this site, Jeanie Wolfson (Naomi), It's Not Mental, really gave us the conviction that we can get through this without meds. Another one by Dr. Hyman, the UltraMind Solution, gives some medical aspects on nutritional approaches. A really good book by Dr. Campbell-McBride, Gut and Psychology Syndrome, talks intensively about diet and intestinal health. Be sure to get the accompanying cookbook. We resisted the full blown diet approach for some time, but we had several lab tests indcating fungal overgrowths and intestinal leakage. It was the only logical thing to do and it is working wonders. The diet is a lot like the Atkin's diet. I was the bread and potato king before the diet, now when I see a loaf of bread, it is repulsive to me and I'm really liking the veggies.
The True Hope products are quite popular, and are a good generic starting point for supplements. Their web site has a lot of literature and journal articles related to their products. Lastly, there are a number of good webinars on the Great Plains Laboratory website. To go beyond diet and True Hope, you probably would need an integrative medicine doctor who is familiar with mental health issues.
At one time, I thought the CAM techniques were just for children who were not nearly as severe as our child. But now I believe it is the only way our daughter can find stability and grow up to have a normal life. The psych meds are just plain wicked. For us, they never worked for more than a month or two. At first, they were wonderful, then they didn't work anymore and we upped the dose. Then it was upped again, and it helped for a few days, then it was upped again, until it couldn't be upped any more. Then another one was added which helped for a short while. It was upped. Then another one was added, and our daughter started having heart troubles. Then another one was added and now she was sleeping all day and would wake up raging with big black circles under her eyes. Then we had an emergency hospitialiation. Then the meds were changed again, and we had potentially serious side effects and more heart troubles. Then a very serious psychiatric episode and another hospitaliation........
Now that we have worked the diet and supplements, she is on a tiny fraction of the meds and we have a very happy daughter. Except for maybe a minor fit at bed time or when she doesn't get her way, you wouldn't even know she has a mood disorder. We are working at getting rid of all the psych meds, except for maybe a very low dose of lithium (below the side effects associated with theraputic levels). Given how well she is doing, it is just a matter of time so that we avoid the withdrawals and fine tune our approach. I guess we were lucky to have a few early indications of success. For us, the CAM approach is a LOT more work than the pill from the doctor, but it is also much more successful.
But regardless of your choices, we and everybody else on this forum wish you the very best. You might think of joining one of the online support groups. The support group conversations are limited to those who are assigned to your group, are only for the eyes of others in your group, and are only for the eyes of parents with children like yours. The conversations are more personal and less technical. On the forums, there are a huge number of different situations and a lot to learn.
Brian
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Daughter 7 BP/violent rages. Unsuccessful with multiple meds. Now reasonably stable (now with fewer and less intense regressions) on Risperidone + Restrictive diet + EMPowerPlus + AminoPowerplus + NAC + Q10 + low dose lithium + melatonin + inositol (no more Intuniv)
Son (5) Normal
Wife (CathyK now also on TBMF) BP, & trying to wean off the meds.
Thank you! I will definitely check out the support groups. I was wondering if they were online or in-person as I don't feel like I can possibly add much more things IRL with all Liam's specialists & hospitalizations and now having to add a psychiatrist and counselor for Xander.
I will check out the dietary stuff, too...but, honestly, the thought of ANOTHER diet to manage is scary as we are in the process of getting our youngest started on the Ketogenic Diet for seizure control and it's a very intense, EXTREMELY strict diet to follow. Still, if it would help, I'd try it at this point.
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Desirée
Mom to Avery (5/2006) - ADHD/Tenex 1 mg in AM, 0.5 mg in PM
Xander (2/2008) - possible Bipolar; Tenex 0.5 mg 2x/day started 1/20/12, Melatonin 10 mg
Liam (3/2010) - former 28-weekr/multiple disabilities/medical issues, Global Developmental Delays, Epilepsy, Autonomic Dysfunction; 22 post-NICU hospitalizations
The ketogenic diet probably already covers a grain free diet. There are also testing that can be done to see whether the child should be grain and dairy-free, although it includes 3 tests and is an expense which many choose to forego and just try the dietary changes and healing the gut since that is a cheaper route, and safe. Others need those black-and-white test results.
This post, Gut, Brain, Bacteria, and Behavior includes the 3 types of testing - IgG, IgA, and the one for casomorphins & gliadorphins.
This one has a video about the psychiatric impact of neuropeptides: Brain Health: "Crazy" From Casein?? (Doped with Dairy)
--Jeanie aka"Naomi"
ItsNotMental-FaceBook
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 a little EMpowerPlus back on as a multivitamin simply 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.
Desiree,
Probably what you were taught about mental illness in very young children is rare is correct, but it does happen. Unfortunately we have many families on this site who started dealing with these issues before school age. The most tragic part to me is when the professionals blow it off or refuse to treat. It's also a pretty good sign that if you have other children who do not have these problems, then it's not your parenting to blame.
Your training in SW should serve you well in learing how to manage your ds's problems, as well as navigating the system. I completely agree with Brian and Jeanie about looking at nutritional issues, also allergies, hormonal irregularities and food intolerances.
You sure have your plate full, but you've at least started down the information path for helping your child.
--
Brenda,51, TBMF Parent to Parent Volunteer
Mom to A, 17 1/2, BP, Tourette's, OCD, ADHD: Eskalith CR, Lamictal, Cytomel, Allegra
E, 16, BP,AS: Seroquel, Eskalith CR, inositol, Buspar
B, 14 1/2 & H, 11 1/2
Married 18 years to DH, 51
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.
Hi. I just joined tonight and saw your post. My son was diagnosed as bipolar at 3.75 years...I knew something was off almost from birth, though. I wasnt fully on board, but the abilify helped a bit, a nice band aid. We just had a second opinion done at the kennedy krieger institute today (hes now 4.5) and although they wouldnt "confirm" they said that they were pretty positive it was bipolar. Im strongly against giving children meds, however, in our case its either meds or in patient hospitalization...hes that violent, angry and has hyper sexual tendencies. So, no, you are not alone. Not only with a child that young with bp, but with hating the meds. He was off his meds for 9 days starting 2 weeks ago and I was overwhlemed. I didnt realize what a diff they were making. Although just a bandaid, it was a MUCH bigger band aid then I realized...
Thank you all for posting the nutrition info and the other forum suggestion, off to check that out!
--
Just Keep Swimming...
Desiree-
Been almost exactly where you are. Knew something was up with our son (now 14 yrs.) shortly after birth. By 18 months, he would have overly-aggressive outbursts, such as to being left alone at bedtime, hitting walls and hitting us when he was frustrated. By 4 he was hitting and kicking hard enough to send wife to hospital w/ a broken nose. At 8, he kicked his bedroom door completely off the hinges with one kick. Thru some bad advice we didn't start addressing his issues with a pediatric psychiatrist until after this, but the door was the tipping point. What had us confused was that--unlike in your situation--he was almost always under control in social settings, but really let loose at home. For him home was a safe place where he could let loose.
Since you're finishing your degree, I'll be a bit more technical about what followed. When we did start with the psychiatrist, his first step after reviewing descriptions of our son's behavior was to order a complete metabolic panel (including a 24-hour urine) to check serotonin and catecholemines, an EEG (he'd has some signs of pediatric epilepsy too), and an EKG (to check for long-QT syndrome). (Most doc's diagnose purely on behavioral symptoms, prescribe thru trial and error, and are completely ignorant of current developments in pharmacogenetics. Not ours.) His metabolic results showed low seratonin, an extreme imbalance between his levels of epinephrine and norepinephrine, and an extremely low level of MHPG (Note 1). The behavioral and medical factors combined to confirm a diagnosis of BP.
Once we had the diagnosis of BP for our son, we had our 3 year old daughter tested. Results indicated she too would also likely develop BP - abnormal catecholemines including very low urinary MHPG. She has now developed behavioral symptoms at age 9 and we just started treating them medically. (Doc didn't point out her MHPG level when we reviewed results at age 3, but did now that she has developed behavioral symptoms - no self-fulfilling prophecy.)
Old guidelines (incl. DSM-IV) don't recognize BP in children, so many docs don't diagnose it even though it clearly exists. (DSM-V apparently is going to move towards more mood/behavioral disorders nomenclature, which I think BMF opposes for BP. (BTW, I'm an org. psychologist, so DSM is familiar ground, but clinical psych is not my specialty.) Further, docs usually say that there is no specific test for BP. While they are technically correct, very few ever test the catecholemines or understand that MHPG can be a highly predictive indicator.
I'm not sure what your doc meant by not prescribing meds because of insurance--his/hers or yours? We signed a waiver w/ our doc to prescribe meds for our kids off-label. We've had no issues with our health ins. getting them covered, but we have a PPO.
If you do end up going the pharmaceutical route, we found that getting a genetic screen for cytochrome P450 was imperative for us avoiding major side effects and interactions. (Search on pharmacogenetics for more about this field.) We found that my wife, I, and both are kids don't have the gene necessary to create the enzyme necessary to properly metabolize most of the medicines typically prescribed for mood disorders. We've used this information to find drugs that are effective and to avoid developing the many side-effects that occur when unmetabolized compounds reach toxic levels, leading to side-effects.
Our son is now nearly 15 and well controlled, with minimal side effects from meds. He has his moments, of course, but most of them seem to be related to normal teen-age hormone changes. We're still titrating the meds for our daughter and hope/pray that we get to the right meds soon.
While I know this has been long and detailed, I hope it's been helpful. I'm the kind of person who deals with new hurdles by gathering as much information as I can, and have appreciated the way our doc has really educated us so much about both the medical and behavioral side of things. Hopefully you, or someone else lurking on the board, will find it useful.
Hang in there!
Dave
(1) Research by James W. Maas - a biochemist - repeatedly showed that extremely low levels of MHPG in were present in patients with BP, different that those w/ unipolar depression and other illnesses.
Hi Dave, We used metabolic and genomic testing to help my son, finding issues like you described. We used Genova Diagnostics to check the P450 enxymes, along with the Phase 2 enzymes. http://www.gdx.net/product/10038 While my son had an optimal Phase 1 panel, phases 2 and 3 were impaired- I found this article was helpful in explaining the process- http://www.lef.org/protocols/metabolic_health/metabolic_detoxification_01.htm
When my son was dx'd in 2003, I began tryingto get a better understanding of what his illness was. I was interested in the testing that you talked about, but I was told there was enough info on what obtaining the 'data' meant, and therefore, the drs wouldn't order the tests. I finally went to an integrative MD. Once we had the metabolic profile, we were able to modify diet with eliminations and supplements to a point where my son has been stable for several years. I found it interesting that Maas was making the correlations 35+ years ago.
Thanks for posting.
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Darryl - parent volunteer, dad to
Levi, 13, stable using supps and diet exclusively since June 07. Previously treated and stable with med combo inc. lithium, 900mg seroquel, and small amounts of risperdal, luvox and focalin after being dx'd at age 3 1/2.
"When you change the way you look at things, the things you look at change"- Wayne Dyer