At what age is the dx done?

[stimpy6298]

My wonderful son is 3 1/2 and has a very long story already but I could talk your ear off so I won't go there.
He was diagnosed with ADHD by 3 different psychologist and recently with ODD and from the beginning I had wondered if he was Bi Polar I know he is too young for a dx right now but he just started on Resperdal 0.5mg twice a day he also does 5mg 3 times a day and a half of pill at night. He has been having horrible mood swings or outburst I don't know what to call it but he will hit, cussing, throw thing, kick holes in the wall and cry the whole time about 10 after he will simply get up and ask me a question like nothing ever happened. He does it a couple times a day.
Thursday morning he got up and said mom I want to make a pinky promise that I will not be mad today. But poor boy seems like he has no control over it and anything or nothing at will set him off. If e.g. my youngest son just looking at him will send him in a crazy fit.

I am sorry I am going on and on but does this sound like Bi Polar or something totally different?

At what age were you guys dx. He will be seeing a pediatric psychiatrist that specializes in pediatric Bi Polar disorder in a couple of weeks. What can we expect?

[QueensU_girl]

Bipolar 'mood states' last for longer than a few MINUTES or hours, i understand.

e.g. people are sick for weeks at a time with mania, hypomania or depression. Multiple Outbursts and mood swings in the course of one day, are not generally 'bipolar'.

People (incl. doctors) who believe that --> "person with 'angry outbursts' must be bipolar", are NOT interpreting the DSM criteria properly. Lots of things can cause angry outbursts and violence in children (and adults too).

Bipolar kids can also show signs of psychosis, too. e.g. a child may say "mommy, there's a bomb in my bottle", etc. (That would make me think "bipolar? schizophrenia?".) You do not mention that stuff [delusion; hallucination] happening.

---

His outbursts sound more like Conduct Disorder than bipolar.

Have you read up on early onset 'Conduct Disorder' or Oppositional Defiant Disorder?

http://www.aacap.org/cs/root/facts_f...nduct_disorder

--

I do know that diagnosing SEVERE mental illness in kids is really hard (if not impossible!) before age 6 or 8. [If it were myself and my kid, I'd get several professional opinions.]

[stimpy6298]

He only says stuff like he is going to hurt someone or himself. In the car the other day he wanted to go see his grandmother and he said if I didn't take him to her right now then he would shoot me. He always talks about shooting people. So do you think that the resperdal is not going to work for his mood swings?

[QueensU_girl]

I can't say about medications. I am not a doctor and we do not give medical advice here.

I'm just saying that "threats" to "shoot" or do "self harm" and acting antisocial and attacking and destroying is not just "ADD".

He may have some ADD (memory or learning or organization problems or hyperactivity), but he's got more happening too...

Lots of us ADDers here have never been ragers or attackers or threateners or aggressive or irritable like this.


Here is a link to an article on Understanding Violent Behavior in CHildren.


http://www.aacap.org/cs/root/facts_f...nd_adolescents

[adhdogwalker]

Someone please correct me if I'm wrong, but I have done a lot of reading on bipolar disorder in both adults and children. Based on what I've read, mood swings in bipolar children can last moments-- they cycle much more rapidly than adults do. Hence, your son's outbursts could be a sign of bipolar or something else. My downstairs neighbor is a clinical psychologist and specializes in mood disorders in children and adolescents and she is of the opinion that bipolar disorder is overdiagnosed in children. I do also know that the antipsychotics (such as risperdal) have a much higher instance of weight gain in children than in adults. They can be extremely deliterious to their health and should only be used with extreme caution.

From your description of your son's behavior, I do agree that he needs some type of psychiatric/psychological help as his behavior sounds beyond the range of "normal" for a 3 1/2 year old. I would definitely seek a 2nd and perhaps even a 3rd opinion before making a definitive decision about how to proceed in treating him. I would also do a lot of reading on bipolar disorder in children as well as on conduct disorders. The more educated you are about psychiatric illness in children, the better advocate you can be for your son.

If you have any questions about bipolar disorder in children, please feel free to pm me, I can ask my neighbor (she's a professor at Columbia & doing an NIH study on mood disorders in adolescents so she's a great person to ask.) I talk to her fairly often about my own bipolar and ADHD and she always shares lots of interesting information about it with me.

[Matt S.]

Since I actually grew up with bipolar disorder, I guess I feel obliged to post.

My sleep as a child was practically non-existent. On a good night I would wake up at 2 a.m. after a good 2-4 hours of sleep.

My moods were always all over the place. I never really went 'down' per say but I was in an irritable nasty mood most of the time because I would refuse to take medicine, there was of course at that time nothing wrong with me.

I had these fits of rage that would take over, like I was being controlled by something else. They at a minimum would last 4 hours but most of the time lasted anywhere from 4 days to two weeks. I would set things on fire, I was physically violent, I would destroy the house at 2 a.m. I had to get arrested at times and go to the hospital and receive an injection of Ativan and Haldol.

I recall being fixated with making international calls, I had always been touchy and never liked being bothered (I am still like that). I then had these periods of giddyness and I was "Mr. Giggles" and I would act like Jim Carrey. I was trained to sing as a child so during these periods of time, even if it was the middle of the night and everyone was sleeping I would break out in chorus and not stop singing until I lost my voice. I thought I could fly, once. I used to run out in front of cars as a game because I was 'invisible'.

I talked constantly unless I was medicated for both bipolar and ADHD (still do) I remember periods where as much as I wanted to I could not stop talking at all.

I am describing behavior that occurred prior to the age of 8 here too.

I hope that someone with actual experience is of some help because there seems to be conflicting opinions so far and reflections on my experience may help quell your anxiety.

[amiegrace]

I work with several children who have been dx'ed with BP at young ages (they are now 9 and 10) in a special needs classroom.

I am not a doctor nor do I have advanced psychological training, BUT I have read extensively on this subject, and from what I have witnessed and seen, there's a good possibility that bipolar might be something for your doctor to consider with your child.

With the children I work with, they tend to have a lot of the symptoms of ADHD, but the mood swings are incredible and they cycle so quickly it's hard to keep up. The talking can be constant and irritating, they can be giddy one minute and talking about shooting someone or being dead the next minute. The children I work with do not go into extremely violent rages, but they are prone to outbursts of hatefulness. After an outburst one of my children at school will erupt into tears and talk about how he doesn't want the "bad one" in him to win.

However I read somewhere too that a child who had uncontrollable behavior was put on a food elimination diet (no additives, no artificial colors or sweeteners, elimination of common allergenic foods like dairy, chocolate, citrus, etc.) and that really helped her behavior. That's an anecdotal thing that I've heard several times.

Hope you find relief, this must be very painful for you and your son.

[Matt S.]

I started getting manic when I was five. I recall one incidence of being wound up for a few days and unable to sleep and I ended up staying awake until I though my bed had opened it's mattresses up like a mouth and was telling me it was going to eat me. Well that is my earliest memory.

I hope that the perspective of the sufferer helps you a little here.

[drjudi]

I am a psychologist, and mother of three. I hate to second guess a psychologist who has actually seen your child, but I have to wonder why you have seen three psychologists already. I also hope your child's medication is being perscribed by a psychiatrist who specializes in treating children. Resperidal is a powerful antipsychotic medication. While it sounds like you have some behavioral problems, four year olds are champions of mood disregulation. When my oldest, who is not ADHD, was three my friends told me that four was worst than two. I could not believe that four year olds could be more difficult than two year olds, but sure enough they were right. I have no way of knowing if your child's problems are beyond what is normal for a child his age, but if you have not worked with a clinician around behavioral interventions long and hard, I would go back to that step. I am not suggesting you discontinue any treatment your child is recieving now, after all the professionals you are working with have seen him and I have not. I am just suggesting that you try some behavioral treatment if you have not already.

Even with all the challenges you face, he sounds like a sweetie.

[stimpy6298]

To start we have seen three different doctors because 2 had to do a lot of testing of different things to see if he needed therapy. They decided he did so he nows sees 1 psychologist who is very good with behavior modification, but said that he has to be able to function normally day to day so the therapy will work. So she referred him to the pediatric psychiatrist who we are waiting to see.
He has started to improve since starting the Resperdal but today was his first day back to preschool and they said he is not the kid he was before and he had his head in his hands all morning and would not make eye contact? I wonder why he was like this because he was fine all weekend. Besides being extra tired which I took as a side effect.

Thank you all for your input, it has been very helpful.

[drjudi]

He is tired because Risperidal is a tranquelizer. If he is tired and lethargic, he is going to be eazier to handle. I assume that his temper tantrums are outside the normal range, but I am incredulous that a psychologist would give a 3 and 1/2 year old child diagnosis of ODD. I am glad that you are seeing a therapist with a behavioral background, but I am a bit confused by what she means by needing to behave normally before he can benefit from therapy. I am also glad that you are taking him to a psychiatrist. I know finding one to treat children can be challenging. You are clearly trying to do everything you can to care for him. I have found in raising my children that no matter what they may be going through it will pass. They keep growing and maturing even though I have forbidden them to do so. Your son will too.

[amiegrace]

Matt -- sounds like a terrible experience. Did you have night terrors as a child?

Stimpy -- the thing that I would be concerned about if your child is bipolar, especially as a child, would be the "brain damage" that may occur from uncontrolled mania/depression. From what I've heard, and correct me if I'm wrong, the brain can actually lose its ability to regulate itself more and more as episodes continue to be untreated.

One of my student's moms put her child on Risperdal for a few days and it was like night and day. The child never seemed happy, talked about killing people and stabbing herself, but those few days on Risperdal and she was like another child. She is 9.

Mom took her off the meds saying she was having side effects (that we didn't see at school). Mom does not spend much time with the child (has a behavior worker for 3 hours after school, mom sees her for an hour and a half and then she goes to bed and to dad's every other weekend), so I'm not sure she sees the severity of what's going on during the day. Her child is a pariah because of her illness and her behavior, but Mom finds something wrong with all meds.

I think that this child's teachers would be able to see if he is simply a stubborn 4 year old, hyper, or markedly different from other children at his developmental level. If the psychologists are seeing something, and the doctor is willing to prescribe what they know is a very powerful medication, they might be balancing out the effects of the meds with the effects on the life of the child who is suffering in this manner.

Such hard decisions for a parent to make.

[umami]

Okay, so other posters are correct that oppositional defiant disorder & conduct disorder are generally diagnosed later than 3 1/2 years old (It should be diagnosed at least after 5 y/o).

One important distinction to make is that undesirable behavior can be pathologic but it can also be normal & understandable in a given context (eg, major life stressors such as the divorce of one's parents, the death of a family member, moving due to a parent's job...). Has your son experienced similarly stressful events lately?

In terms of putting kids on antipsychotic medications such as Risperidone, Risperdal, Zyprexa, Abilify, Ativan, Haldol, etc. --it is possible that such medications could ultimately affect the child's cognitive development in severe, negative, and PERMANENT ways. Only licensed, experienced child psychiatrists should be treating children with suspected schizophrenia, bipolar disorder, psychosis NOS. It would be a good idea to start researching these meds so that you know what questions to ask your son's doctor when the time comes.

Another comment: not to sound preachy, but parent's prescribing psychotropic meds for their children raises a lot of ethical problems too, so I wouldn't consider the case of the mom testing risperidone's effects on her son/daughter as an example to follow... Antipsychotics are not like stimulants in terms; stimulants have a better established long-term safety profile with few side effects. Not so for antipsychotics.

It definitely sounds like this is something that requires more time looking into. Keep us posted on the outcome of the meeting with the Child BP psychiatrist. I sincerely hope things improve.

[stimpy6298]

No, he has not had any major changes recently, his brother is now 15 months old and Jeremy still has a huge problem with jealousy and rage against him. His father even changed shifts so he could be home in the evening to help control him.

I have a new question he attends a government funded preschool and they had him evaluated by the school corp. psychologist due to the aggression , hyperactivity, inattentiveness and problems following directions, and not being able to make eye contact. ( I have never had a problem with him looking at me). So they did 2 evaluations and I just received a copy today.
It says that they did a WPPSI-III and scored average on Verbal and full scales then it says that he scored low average on Performance(non verbal) and general language(single word receptive and expressive vocabulary) scales. Subtest scatter was not great in his case, and that the test did not reveal any notable mental ability weaknesses. They said he tested low on the Beery VMI and scored solidly average on the Bracken School Readiness Composite.
He does not have any learning problems, though he presenting behavior problems of a emotionally disordered preschooler. What does this mean?
Though they said he didn't have a learning problem they are recommending to the committee that he be in consideration for special education services.
Why?
To my understanding I thought that special education is for learning disabled kids. Am I wrong?

[drjudi]

Special education is available for children with all types of disabilities starting at age 3. I am so glad that he has been identified early so he will get the educational intervension he needs to be successful. The WISPPI is a great measure of intellegence. It sounds like his intellectual development is normal. It is not unusual for preschoolers to develop verbal skill or physical skills at an uneven rate. The only thing I would caution you on (and you have probably already been told about this) is that an intellegence test given before the age of 6 does not predict future intellegence. So he may need to be tested again in a few years.

My heart goes out to you and your son. You sound exhausted by the challenge of caring for him. My first two children where about the same difference in age as yours and I remember how difficult it was. I know it seems endless now but it will change. It won't necessarily be easier, but definately different.