My 3 year old son has always seemed to have a "temper" as long as I can remember, but as time has progressed he has gotten worse and worse. He has terrible rages daily, sometimes several times a day. Often they are brought on when we tell him "no" or something goes differently than he wanted. Other times we aren't always sure what is wrong, but obviously something is.

During these rages he screams, cries, bangs his head, strikes out at us (his parents and his brother) - hitting, pulls our hair and won't let go, bites us - and when he bites he doesn't just bite he bites and hangs on until you pry his jaws open and get away from him. He is small, but when he is going through this he gets almost super-human strength (for his size) - he knocks over dining room chairs, tried to flip over the table, throws any and everything he sees, even some things that were his favorite things (which made him even madder). We have to just do whatever we can to make sure he does not accidentally hurt himself while doing all this, while trying to dodge being attacked ourselves.

Our other son is 11 months older than him - they both have the same mom and dad, both are raised together in the same environment, both treated the same way with the same rules, but the older one does not behave like this at all. He may have a typical tantrum, but nothing like the three year old.

When the three year old has these fits we've tried re-direction - changing his attention to something else, but he is SO wrapped up in his rage that you cannot reach him - if anything he gets madder. In the past we've tried time-outs, we've tried talking to him and telling him that hitting/biting etc hurts and we don't do that, we've tried most everything that is normally recommended. We can rarely take him into public (such as a restaurant) because when we do he often starts crying/screaming for some unknown reason, then people start sharing words of wisdom - you know, like "that kid needs his butt spanked" (real helpful).

So, we finally decided that he was just getting worse, not better so I started looking into who we might talk to about this. I took him to his regular pediatrician and explained what has been going on. The pediatrician said since our son is so young he would like him diagnosed by a psychiatrist.

We pay for medical insurance out of our pocket ($700+/mo), but it does not cover any behavioral medicine, but this is serious enough we decided to do what we could to get him help. We only have one actual child psychiatrist here but she does not see children under 5. We found another psychiatrist who does treat primarily children and adolescents so we went to him.

On our first visit my son played with toys (in the same room) while the psychiatrist asked me a lot of questions - mostly about family history, and about Sons health, asked about how he has done with his milestones (walking, talking etc), and listened to me relate the problems we're having with him. At the end of the interview the psychiatrist said he had some meds in mind but first he wanted to get blood work, thyroid test and EKG done. I asked him if there was a name for the condition that he thought son had and he said "Intermittent Explosive Disorder". He told us to go get the labs etc done and come back in a week and we'd talk about meds.

We went back for the next appt and all tests came back okay. Then the doctor said he wanted to put Son on Strattera. I was surprised because the doc had not mentioned him having ADD/ADHD at all the week before. I told the doc I really don't think he has ADD (at least from what limited knowledge I have) because he is able to concentrate on things he is doing, he isn't fidgety or over active (except when he has his outburtsts). I stressed to the doc that my main concern was the anger/aggression/rage - whatever you want to call it. The doc told me that he really thinks the Strattera will help him, and if it doesn't help him we'll be able to tell pretty quickly and we can then try something else. Well, he's the professional, not me, and I AM paying him a lot of money to tell me what's wrong so I guess I should give him a little more credit for knowing what he's talking about. Even if we can find another psychiatrist to take such a young patient we cannot afford the initial visit fee again, so we will have to do the best we can to work with this one. I don't have a problem with the possibility of my son having ADD/ADHD, I was just surprised. Since our family tree includes alcohol/drug addiction and I was in the past treated for bipolar I was thinking more along the lines of manic episodes.

So, for now we are trying the Strattera - which only comes in a capsule - I told the doctor that son would not swallow a capsule, but he told me to try anyway. Didn't work, but we found a pharmacist who compounded it into a suspension. Today was the second day he's taken it. Thank goodness he hasn't gotten sick from it as I was afraid he might, but I haven't seen any quick diffence either as the doc said I would. (I have since researched this drug and found that it can take weeks to see a difference). He still had outbursts yesterday and today that were deffinitely not better than normal - if anything they were worse.

We go back to the psych Doc in another week and a half so I will give the Strattera a chance to work and hope it does, though I am afraid it won't.

I know no one here can give specific medical advice, but I am just wondering if ADD/ADHD does sometimes presents itself in the way my son is presenting?

Any thoughts or advice are welcome.

Thanks

It sounds like it could be ADHD related - ADHD isn't associated with excessive rage, per se, but associated conditions certainly are - like oppostional defiant disorder. Part of the problem in diagnosis would be your sons age - I imagine it's pretty hard for a psychiatrist to know what's going on in a 3 year old's brain - and I'm not sure a 3 year old is developed enough from a personality standpoint to be ODD - all 3 yr olds are defiant, after all, and it could be that if he has ADHD, it could "magnify" what is "normal" 3 yr old defiance into a rage.
Your family history could be indicative of ADHD as well - addictive behaviour is a trait common to ADHD.
Strattera does take some time to work, but depending on the dosage, and how slowly it's increased, you will usually see results more quickly than several weeks - anicdotal evidence I've read suggests most people see results in a week or two, or not at all - but of course this is my unscientific opinion - your Dr should always have the last word on such things.
Good luck,
Greg

It sounds like the going through the "terrible 2's" at three years old. Maybe there is some sort of develomental delay which may be related to or in addition to the AD/HD. If there is a delay he may not understand things the same way your older child did at that age. He probably isn't connecting why he can't do something or why things are different.

I would also look into the possiblity of an autism spectrum disorder or a communication disorder.

It sounds like the world around him doesn't make sense to him and he is totally frustrated.

My other son went through the terrible 2's (and 3's, lol), but they were nowhere near as serious as this thank goodness! :dizzy:

You are not the first person I have met online to mention autism spectrum disorder, so I am deffinitely going to research that as well. I never expected I would be doing so much research on these things!

Thanks both of you for your replies. It's nice just to be able to talk about it! :D

Please check out The Bipolar Child by Dimitri Papolos. It is now recognized that Bipolar Disorder is frequently misdiagnosed as ADHD. They have many features in common. However, the rages you describe are not characteristic of ADHD kids as they are with Bipolar children.

My 7 year old daughter was diagnosed as having ADHD. She has been on Strattera for 8 months. It seemed to help with the hyperactivity in the classroom, but has done nothing to help her settle down at bedtime, stay seated at dinnertime, or help her get up and going in the morning. She also has severe insomnia and is frequently irritable and has mood swings. She also complaints of nausea from time to time. I have taken her off the Strattera because these are possible side effects of Strattera. Because it is a mild anti-depressant, it has the very slight possibility of precipitating rages in bipolar people, but I don't know if there is solid research to support this. Her rages at bedtime have become more frequent in the last month, as well as temper tantrums during the day. I am guessing Strattera is probably not the correct meds for a bipolar person. I don't know for sure if she has bipolar disorder. It has been suggested by the psychologist we recently started seeing for therapy. I have an appointment with a new psychiatrist and am taking her to a new pediatrician to rule out any medical causes for her behavior (e.g. thyroid and/or blood sugar problems, or metal toxicities, among other physical problems, can cause behaviors such as rages and hyperactivity, and therefore they may not be indicative of a psychiatric disorder at all.)

Best of luck,

Lisa

Hi!! I have read before that terrible 2's that do not go away are a red flag for ADHD. This also can develope into ODD. We had both of these and finally at age 6, I could not take it anymore and sought tx. for my daughter. I am a firm believer in early diagnosis, and tx. It heads off alot of stuff that becomes learned behavior. Also I have seen alot of kids with comorbids not do well on Straterra. It does take time to reach the full effect. Also you may see some increase in rages and your child may become nore emotional. These should go away if Straterra is the right med for your child!! Good Luck!!

Smom,

I can definately relate to your situation. My son is now 5 years old (turning 6 in Nov.) and we have been dealing with his behavior since he was a 1 year old. My husband is in the Marine Corps and has been since before he was born. His behavior started about when his daddy left on a 6month deployment that was when he was 6 months old. It wasn't severe or nothing, just crabby alot but thats typical for a 6 month old who misses a parent. I had his little brother also while my husband was gone on that deployment and they are 15 months apart in age. He really started then with the agression which he was only a year old. He would slap me across the face in public, and throw fits in front of everyone. He even went as far as kicking a nurse in the doctors office and slapping a doctor. It was then they told me to start spanking him to get control of him. So like a dumbbell I listended. He got 10 times worse after that he would hit me harder and even tried to smack his 3month old brother so I had stopped the spanking and found a new doctor. After a million doctor visits to a naval hospital and a civilian doctor we found out after he turned 2yrs old he had fluid built up in his ears which could have caused the speach delay. They sent us to a specialist and they did a exam on him and came to the conclusion he lost some slight hearing his left ear, but not enough to cause any problems. when we arrived out in California 2 years ago we enrolled him into head start/preschool. They enrolled him into speach therapy since no one could understand him, and that helped greatly. Mean time the hitting and temper tamtrums still continued. Everyone said it was a phase. He is now 5 years old and my husband left for 45 days and it was horrible. He is now using his fist to hit, and has left brusies, and welts on his little brother who is now 4 years old. I'm scared and I cry a lot. I'm scared that one day he will hurt either his little brother or someone else for that matter seriously. It is almost like he doesn't comprehend what he is doing or realize that it hurts. We have taken him into a pediatrician here and I begged for help, telling him either they help or they are going to have to put me on medication. After doing an intial assessment of watching him and listening to him react to me and my husband the doctor seems to think it is adhd related. We go back in next friday the 20th for another consult with him, this time we had to get an assessment from his kindergarten teach he had last year. But counselors do not work, he refuses to talk to them. He won't even talk to the doctor or nurses. He would not even cooperate with the ear exam. Which we have discovered his ear drums are pushed back so we have an appointment coming up for that too, concerning putting tubes in to help him with that. We have thought that could be causeing a lot of frustration also with him not hearing properly. This is very frustrating to me as a parent since it seems that I am getting no where and am getting no answers as to what could be causing him to have all this anger bulit up inside of him. Hopefully, I will get some answers next friday and begin to find a treatment then for the situation.

Best of luck with yours and hope you find answers soon too,

Leta

My son now 9, started with the rages around 18 months, also daily, several times a day, and like y ou nothing could calm him. !!! And I tried it all. He kicks, hits, spits, throws things etc...to make a very long story short I too suggest reading the BiPolar Child. My son was dx with bp at 5, he had and has severe mood swings from calm, to crying and screaming over the most minor things (the wrong yogurt) and especially if he is denied something, or asking him to wait for something. He gets very focused on something and can not get the thought off his mind (called Mission Mode) and will, the longer he is denied it the more angrier he gets, for hours!!!! You can also check out the Child and Adolescent Bipolar Foundation website and it will give you the symptoms to look for. Bipolar and Add/Adhd are closely related, but bp is more extreme, more irrational and unpredictable. Frustration is definitley my sons worst enemy, he does not have the ability to recognize he is getting frustrtated, therefore can't stop or calm down BEFORE the big rage occurs. Good luck, if you have any questions just ask, I have been living and studying this illness for almost 5 years now.

Kim Hix

The 5 distinguishing features between bipolar kids and ADHD kids are:1)bp kids display an Elevated Mood; 2)bp kids are prone to Grandiosity ;3)bp kids display Flight of Ideas (racing thoughts vs poor concentration) ; 4) they have a Decreased Need for Sleep ; and 5)bp kids display Hypersexuality.

Sounds just like my nephew before he was dx'ed with PDD. His rages are what you discribe your son as doing.

I must disagree with mctavish 23, the 5 distinguishing factors for adhd and bipolar are not quite accurate. There are several subtypes of bipolar, bipolar l, bipolar ii, bipolar mixed, bipolar rapid cycling, bipolar with psychotic features and cyclothymic disorder. Not all kids or people with bipolar disorder are hypersexual, only some of those people in their manic state may SOMETIMES become hypersexual. My son has bipolar with unipolar depression, he does not get manic, but switches from "even or normal" to depressed and sometimes hypermanic at which time he exibits the irritability, rages, anger, crying spells, some mild hypomania when he can become defiant and sometimes grandiose (thinking he makes the rules no mom and dad) he has never been manic, never had flight of ideas, never stayd up all hours of the night, never sexual much less hypersexual. Bipolar disorder is a very difficult and intense illness with many factors that come into play, similar to add/adhd.

I wasn't talking about the subtypes of bipolar. I listed the differences between bipolar kids and ADHD kids. That info came from a Continuing Education cd featuring a psychiatrist making a presentation to a group of colleagues on bipolar children. I'll be glad to get material from my office and list the reference correctly.I also didnt say every bipolar kid shows all those differences, anymore than ADHD kids have all the possible symptoms. These are the 5 main (research driven ) differences.

Since there's no definitive test for either disorder it can be very difficult trying to distinguish one problem from the other; as they often overlap.The list is one research based tool that therapist's/clinician's can refer to in trying to make a differential diagnosis.
I just attended a workshop on bipolar kids in Duluth,Mn. and the cd I listened to was also referred to by the presenter as containing some of the latest research results. The presenter also brought up some other distinguishing features based on her (anecdotal ) experience; meaning it isn't research based. What she said was that bipolar kids are more often "in your face" and also prone to being destructive. Since I've seen the same thing many times myself it made sense. It would be nice to see some data on that as well.
I apologize for not listing my reference source and will drop by the office and pick it up later today. Thank you for your comments and I wish you and your family well.

The reference for those data is from The Psychiatric Times, Vol. 1.No.2 May 2003.
The presentation was "Managing Bipolar Disorder in Children and Adolescents " with Karen D.Wagner,M.D., PhD. Clarence Ross Professor and Vice Chairman,Dept.of Psychiatry and Behavioral Sciences,University of Texas Medical Branch.

My son is definitley the "in your face" kind. And very destructive when angered. We can't seem to get the explosive, angry side to go away, regardless of meds (Seroquel and Depakote). I seem to think that is something we will have to live with. His therapist does a good job while we are in the office, but once home and in the midst of his rage/anger, he is unable to draw on anything discussed in the sessions. He just explodes, no ability to calm himself or "step back" to analyze or think things through.

I looked the CEU material over further and found the actual research study Dr.Wagner was referring to. Here it is:

Geller B.Williams M, et.al.Journal of Child & Adolescent Psychopharmacology.2002;11-25.

A different study by those same authors reported an 87% comorbidity rate between Bipolar and ADHD. Last year Barkley reported "up to 92%" comobidity rate.

Geller B,Williams M.,et.al.Journal of CHild & Adolescent Psychopharmacolgoy.2000 (Fall);10(3):157-164.

My 5 year old was just diagnosed with O.D.D. and adhd. I'm still trying to gather info on O.D.D. it is very hard to come by more than just a definition or how the child will act. What we are trying to find is info on how to deal with the episodes without losing our sanity. This past weekend even on the medication was extremely hard. He starts seeing a therapist on monday, the doctor originally wanted a psyciatrist, but the only one here doesn't take our insurance no more. So we are also looking into getting a humatrian transfer to a military base that has more facilities to help us out. The doc upped the dosage on the ritalin but not the clodine as of yet. He said eventually he will be put on concerta, which I assume is stronger and from what I understand that is better for aggressiveness. We did alot of research on bipolar like it was mentioned before, but after reading about it, it doesn't really sound to much like him. He fits the O.D.D. description to a Tee. We'll see what the future holds though, from what I understand and have been told, in kids they can't diagnose by symptoms for bipolar, unless they try medicines for adhd first and they all fail. Then they can switch to mood medications which would be for bipolar.