Fact Sheet: Five Year Old Boy Responds to Two Mood Stabilizers
by Nadine © 1999
An account of the first five years of an adopted son's life until he was successfully treated for bipolar disorder with a combination of two mood stabilizers.
After many years of being diagnosed with recurrent unipolar depression and severe anxiety and taking countless different anti-depressants, I was finally diagnosed with Bipolar I. I was lucky to find a good psychopharmacologist who brought me stability. In retrospect, my doctor believes that I, too, had onset of bipolar disorder in childhood.
After several years of my stability, my husband and I adopted our two boys, one of whom has bipolar disorder. The biological mother of our bipolar son also has the illness.
Frustration and hyperactivity
Our son experienced dramatic mood swings from the day he was born. According to his foster mother, for the first 12 weeks he screamed non-stop and was completely inconsolable. The traditional methods of handling "colic" just didn't work. We brought him home when he was 13 weeks old and were told he had just started to calm down a bit. I remember his foster mother telling me, "You owe me big time! He is the first baby I have fostered that has made me cry." I have paid her back a thousand-fold, but he is worth every moment of anxiety and worry.
I carried him in a sling almost every waking moment for several weeks to help him stay calm and to strengthen our bond. I recall him either being a very happy baby and quite charming to adults, or inconsolably unhappy and fussy. He cat-napped in the sling or on my lap, but couldn't sleep without my comfort and presence. Getting him to sleep at night was a several-hour ordeal from the start. He simply could not settle, nor could he handle being left alone. He slept little. He stayed in our room in his crib at night until he was a little over one year old, then started to wake each time he heard me turning in bed. The transition to his own room was beyond belief.
He had many odd fears from the very start. He was horrified by the lawn. He would not stand on it and needed months of desensitizing before he would play on it. He would also panic if anything went wrong in a story being read to him or seen in a video.
As an infant, he was frustrated at not being able to get around. He advanced very quickly through his gross motor skills. He skipped crawling and began walking at the age of eight months old. He skipped babbling and began speaking with the vocabulary of an adult by two years old. From the very start he was constantly on the move. Until recently, he has never been able to sit and work on a quiet activity. The only way he was able to watch television or videos was to ride on a bouncy pony while he watched so he could keep moving. We have had to be very creative in inventing ways of teaching him things while at the same time keeping him moving and focused. We attended a parent/child gymnastics class and had to drop out because all he would do was to run back and forth in the room nonstop until I picked him up. This would set off a major temper tantrum or rage.
Explosive tantrums and impulsivity
"Temper tantrum" is a mild description of what we experienced from the time he was about 13 months old. The slightest thing (especially being told "no") could set him off for hours. This tiny enraged little dynamo would scream, tears streaming down his face, throwing furniture, destroying things, kicking, punching, biting, spitting, slapping. These rages just became worse as the years progressed and his hyperactivity and emotionality worsened as well. By the time he was two years old we suspected he had bipolar disorder like his biological mother.
Another troublesome, if not most troublesome, symptom was his impulsivity. We had to be vigilant around-the-clock in order to keep him safe from himself and from impulsively hurting someone else. It has been exhausting, frightening and very frustrating.
We tried everything to be good parents and used several behavior-modification plans, to no avail. The defiance even at that age was incredible. At his two-year-old checkup his pediatrician told me we should have him evaluated for ADHD. I actually felt relieved and started to cry and told him what we had been living with. He referred us to a developmental specialist.
First diagnosis: ADHD
This specialist essentially diagnosed our son with ADHD and a "bad attitude problem." We needed to be "more consistent," he told us. We enrolled our son in a preschool that accepted him because the owner was an adult with ADHD and felt she could help him. The specialist began our son on a trial of stimulants that only made him progressively worse. This doctor kept increasing the dosage until our son went beyond manic into a stuporous state with hallucinations. We were extremely concerned and frightened.
We then found a very good pediatric psychopharmacologist who initially told us our son had extremely severe ADHD, oppositional-defiant-disorder (ODD), primary anxiety disorder, and primary sleep disorder. He was also very open to our concern that our son was bipolar and we discussed his history and symptoms at length. He recommended we enroll him in a special-ed day preschool through the local school district and helped us with the referral and assessment process. Over time, and after so many medication trials that we lost count, our son's psychiatrist told us, "you know, I believe you are right. I think your son has childhood onset bipolar disorder with co-morbid obsessive-compulsive-disorder (OCD)."
Our son was referred to a pediatric neurologist for an assessment to rule out "organic" causes for his behavioral and emotional symptoms, along with other symptoms such as not being able to close his eyes, not being able to jump at four years old, etc. The neurologist told us that there was definitely something "very neurologically wrong" and they set up an appointment for an MRI. We were told that no other tests would be made because we were already doing everything they would have recommended no matter the outcome of the testing. His MRI was normal.
Our son's doctor was very concerned and frustrated. Anti-psychotics that can sometimes calm rages made our son paranoid and anxious, even at minute dosages.
Mood stabilizers a turning point
At this point we started the mood stabilizer trials. Our son was put on a trial of carbamazepine, an anti-seizure medication sometimes used to treat bipolar disorder in adults. We worked with the dosages and their timing for months before we were able to get him somewhat stable. He stopped cycling (he had been cycling in a pattern of two days quite hypomanic and one day agitated-depressive), but he was still very hyperactive and impulsive. His obsessive compulsive symptoms were still quite serious.
Several months ago we added valproate and saw a remarkable change. We had our little boy back!! It took quite a bit of "tweaking" of dosages and timing of dosages again, but he has finally attained stability on a combination of two mood stabilizers. He is now thriving and very happy. In the midst of all of the medication trials we found an occasional dose of clonazepine to be very effective on an "as needed" basis for severe anxiety.
Looking forward to kindergarten
Our son just turned five years old and will be starting special-ed kindergarten next week. He is thrilled and can hardly wait to start. We sit back and watch him calmly play with his little brother who previously was terrified of him because of his outbursts of frustration. We cannot believe how far he has come. Such a strong little human being he is to endure all that he has faced in his five short years. No one should have to endure so much pain, especially a small child. Yet we have great hope for his future because he has had an early diagnosis and early treatment. As he grows and matures he will learn appropriate ways of coping with his illness right from the start, as I have. Will he become a doctor? A lawyer? A President? Our wish for him is simply to be stable and happy. Isn't that what we all hope for our children?