Update on Friend

[Deleted]

backstory- child has days of excessive anger and tantrums for several hours of the day.  Not developmental for the child's age or the frequency or length of the meltdowns.

Dad is open to an evaluation. Mom tried to read the books suggested, but is getting stressed out and can't read them.  Had made a few phone calls but nothing yet on an evaluation.  Caretaker that tells me most of the information is wondering about bi polar since there is a family history, which is really scary to me.  So I don't know what the parents are thinking because I wasn't thinking that.  The caretaker (grandma) is in the best position to make suggestions since she is actively caring for the child after school, so I give her suggestions. 

We talked about coaching the older child (not the one that is melting down) in what to do when meltdowns happen because he tried to get involve and "parent", and he makes things worse.  So I told her to take him aside and talk to him about what to do when these incidents occur.

I thought about a calm down corner, but I think he would be resistant to it and that it might be putting a band aid on a gaping wound when really he needs the eval.   Eval for bipolar would be a pediatric psychiatrist right?  Because Developmental Pediatrician is more for autism?  And if it is bipolar, there might be talk of medication at some point in time.  Not sure at what age though.  

[akafred]

IMO he should be seen by a psychiatric professional, either psychologist or psychiatrist.

FWIW, while bipolar can be dx in young kids, it has fallen out of favor with most psych professionals. They are more likely to dx the same child with Disruptive Mood Dysregulation Disorder.

If it were me, I would look for a psychologist who is familiar with and engages (at least in part) in TBRI - trust based relational intervention. We learn a lot about it and Karyn Purvis in our adoption group and it is mostly for kids with this type of explosive reaction.

[akafred]

Also, as mrsbuttinski said in a previous post about this, please invite your friend to come here and discuss this. Better for her to get info first hand, and better for you not to be in the middle!

[Deleted]

I don't think she does online forums. And part of the info is for me.

However, if there is a diagnosis I definitely think she will need some support which with diseases more on the rare side is best found online because other parents in her village may not have experience with this. So that is part of the plan. I don;t think she is ready yet, so we are kid gloving her, but also pushing her for an eval.

[akafred]

What do you think is driving her hesitation? Maybe understanding that will help you address it.

[Deleted]

Dec 12, 2016 11:40:51 GMT -5 akafred said:

What do you think is driving her hesitation? Maybe understanding that will help you address it.

I think it is a number of things.  Right now I think it is fear.  She has a lot of stress and previously her H was against it.  He is on board now.  She has been really sick this fall, and they are doing some house stuff, and the holidays, and she has a job where she is on call so sleep is sometimes terrible.  So I think its like she is so stressed out that she just is falling apart right now.  So we are trying to push this without her totally losing it.  Because I am seeing her more stressed then I ever had.  And the home life is terrible with all these battles, so its like survival mode and everything else is shut out. 

So in my mind I would say hey lets evaluate and get out of survival mode.  In her mind its like one more thing that she has to add to her to do list, doesn't know what to do or if it will help or if he will participate. 

[akafred]

That makes sense. The unknown can be really daunting, and the journey isn't always smooth. But the bottom line is that he is exactly who he is no matter what she does or doesn't do. If he has, say, ADHD (not dx'inf him, just a for instance) then he has ADHD, whether she actually pursues the eval or not. But getting the eval and dx puts him and her in a better position to cope with it.

Maybe her H needs to take the primary role, at least for now, in the medical and therapy appointments. That was my H's hang up when we started the ADHD road. He already does DD's weekly OT appt and did not feel he had the bandwidth for weekly therapy appts, so I took those on until we didn't really need them anymore, and then I dropped them.

[Deleted]

Yeah I thought about that. I'll mention it to her mom that maybe her H should schedule the eval since she has not been able to yet. I'm not sure who she called, but we recommended the top children's hospital in the area, so access to specialists should be good. Not sure on wait time.

[akafred]

A psychologist or psychiatrist not affiliated with a hospital may be another good option. Locally I would only send someone to our hospital if their child was likely on spectrum. I had a bad experience with ours (dev ped) and have heard countless other similar stories. (People being dismissed, told their child is fine, but at the same time parents are blamed.)

[Deleted]

Their's is a very highly ranked children's hospital much more so then I think your hospital is. And we have had a good experience with our children's hospital here also.

She got that same thing from her pedi that he was fine. But he isn't fine. And she brought it up with him several times.

Perhaps there are some doctors with reviews (however affiliated) we could send her way. Not sure where it ended with the phone calls.

[mrsbuttinski]

Dec 12, 2016 9:54:12 GMT -5 @clarypax said:

backstory- child has days of excessive anger and tantrums for several hours of the day.  Not developmental for the child's age or the frequency or length of the meltdowns.


How old is the child and what triggers the behavior? Is the behavior present across structured school, home and unstructured community settings?

Dad is open to an evaluation. Mom tried to read the books suggested, but is getting stressed out and can't read them.  Had made a few phone calls but nothing yet on an evaluation.  Caretaker that tells me most of the information is wondering about bi polar since there is a family history, which is really scary to me. 


Bipolar is a mood disorder. Not sure I'd judge it as "scarier" than some of the other potential dxs that could present thusly. Bipolar can be effectively treated; many people with it do very well with tx. 


A family hx of bipolar also elevates the risk of ASD and seems to be related to ADHD, schizophrenia and other mood disorders. 


So I don't know what the parents are thinking because I wasn't thinking that.  The caretaker (grandma) is in the best position to make suggestions since she is actively caring for the child after school, so I give her suggestions. 


That's likely true. 

We talked about coaching the older child (not the one that is melting down) in what to do when meltdowns happen because he tried to get involve and "parent", and he makes things worse.  So I told her to take him aside and talk to him about what to do when these incidents occur.


He needs to be a child. It is not appropriate for him to intervene in this situation unless he is considerably older and there is no adult present says the 10 year old me who was called to the office to deal with my younger sister's challenging behaviors in school. If he tries to, grandma should relieve him of any notion that this is expected of him. 

I thought about a calm down corner, but I think he would be resistant to it and that it might be putting a band aid on a gaping wound when really he needs the eval.


He needs an eval and possibly a FBA to understand what is triggering outbursts so a plan can be put in place to help him become more resilient and flexible around them.


Eval for bipolar would be a pediatric psychiatrist right? 


A psychiatrist/psychologist team would be a good starting point. Even if there is ASD, they should be able to tease it out. They'd also be best for dxs like depression and ODD which can overlap in terms of symptoms.


Because Developmental Pediatrician is more for autism? 


Dev pedi for developmental stuff like ASD, DS, ID, etc.


And if it is bipolar, there might be talk of medication at some point in time.  Not sure at what age though.


Medication is appropriate. It's pretty unusual to get a bipolar dx before puberty.  

[Deleted]

mrsbuttinski, he is 9. He gets mad at school and has resentment, but tends to hold it in and take it out on his primary caregivers (mom, dad, Grandma, and aunt) when he is at home. They feel they are walking on eggshells all the time. It does happen outside the home also though, so in unstructured events, but not at school since we figure he is holding it in and explodes at home.

This is what I told Grandma to relieve the older child of the notion that he has to help.

There is a family history of schizophrenia and bipolar. No history of ADHD or Autism. We aren't seeing ADHD or Autism with him, but we are not the professionals of course.

Due to the family history we are aware that bipolar tends to come out around puberty. Although this family member exhibited signs before that they were not as severe until he hit puberty.

[akafred]

Our teaching hospital is world renowned and usually ranks in the top 10-20 in the nation. I still don't like them for childhood psychiatric issues, for my experience as well as a few friends and acquaintances. Developmental stuff (ASD, ID) and medical stuff (CP, dS) or most childhood medical situations, yes, but more on the psychiatric or behavioral side, no. Things may be different/better where you are(one would hope), but in this situation I would still prefer a psych professional over a developmental pediatrician. This smacks of psych to me, though not necessarily bipolar. That is where I would start, with a psychologist at a stand alone clinic where a psychiatrist or MD is also present in case meds are needed. The wait list may well be shorter also.

[Deleted]

Dec 12, 2016 12:40:41 GMT -5 akafred said:

A psychologist or psychiatrist not affiliated with a hospital may be another good option. Locally I would only send someone to our hospital if their child was likely on spectrum. I had a bad experience with ours (dev ped) and have heard countless other similar stories. (People being dismissed, told their child is fine, but at the same time parents are blamed.)

I get what you mean though.  My ENT affiliated with our great hospital has been eating crackers for me and has been for a long time.  I really need to switch, but she is a good surgeon and we might be heading down the surgery path again.  But after that, I may move on.  Lately she has been forgetting entire conversations etc and she is so laid back to the point of just not being proactive enough for me.  She is right on the edge which is why the relationship has lasted this long, but lots of caveats before she takes action. 

[Deleted]

Thanks for your help @akafred.

[mrsbuttinski]

Dec 12, 2016 13:07:22 GMT -5 @clarypax said:

mrsbuttinski , he is 9. He gets mad at school and has resentment, but tends to hold it in and take it out on his primary caregivers (mom, dad, Grandma, and aunt) when he is at home.

It could be he's holding it together in school, but when a kid does the worst is generally reserved for mom or mom and dad. I would expect the aunt and/or grandmother to be spared. So that could be a mistaken assumption. It could be the structured school setting with consistent and transparent expectations allow him to hold it together.


They feel they are walking on eggshells all the time.


They probably are and it's clearly not working. My sympathies to all of them. 


It does happen outside the home also though, so in unstructured events, but not at school since we figure he is holding it in and explodes at home.


This information may help them narrow down a dx sooner. It's also possible that this is going to be a complex dx with more than one thing in play. How long has he been struggling behaviorally? This information could give them some clues about whether this is ODD (much earlier onset), depression (which looks like irritability in boys this age), ASD (a lot of mild ASD kids fly below the radar until close to 10 when peers become hardwired for conformity and turn on them), ADHD (there's a huge leap in EF expectations in late 3rd/4th) or just now which does fit more neatly with bipolar. 

This is what I told Grandma to relieve the older child of the notion that he has to help.




There is a family history of schizophrenia and bipolar. No history of ADHD or Autism. We aren't seeing ADHD or Autism with him, but we are not the professionals of course.

Due to the family history we are aware that bipolar tends to come out around puberty. Although this family member exhibited signs before that they were not as severe until he hit puberty.

I hope you can get some answers and relief.

[Deleted]

I would say he has been struggling behaviorally since age 5 when his dad went to work and he started K. I don't think those things actually caused it just the timing. Its more like a child tantrums when they are 3 or a little at 4. Then at 5 and 6 they start to use their words and grow out of it, and he did not. It was also cyclical. So he would have long periods of time where he was better, and now they are in a difficult cycle and he is not coming out of it. I think the fact that he seemed better stopped them from getting treatment sooner becuase they thought he was better, and didn't realize it was going to get worse again.

[theycallmemommy]

I can understand why your friend is nervous and overwhelmed. That's a lot going on. I just wanted to come by and give my experience really quick.

My Dh is in his 30s and is bipolar. He is on heavy meds. He has the angry/ depressed presentation. His grandfather had the happy manic version. It took a really long time to get both dx and it's trial and error on medium.

When I met Dh, we were barely out of high school, he told me about it, but he hates it and rather not have people know, given the stigma. My parents after 15 years still don't quite understand but yhey are more compassionate than in the beginning.

My Dh at first really wanted kids but insisted we didn't because he doesn't want it to live on.

I was adament that we needed kids, he loves kids and when he manages his bipolar taking meds on time and gets rest, he has minimal symptoms but unfortunately it's not perfect. He can get super depressed sometimes with a trigger and sometimes out of no where.

Well instead of a bipolar child, our oldest, 6 has ASD. It's possible he will end up with bipolar as well but not as likely as his little sister might.

[theycallmemommy]

Medium=meds stupid auto correct

Anyway, his 90yo grandma randomly started telling me about her late husband and her mil a few weeks ago.

Her husband didn’t present with bipolar until almost 30. She also said her mil was pretty "intense and crazy" She said this with almost a tear in her eyes and was gazing at my son playing. She asked if I saw any tendencies yet, which we don't. He is very happy and cuddly 99% of the time.

So this post got me thinking about that convo. A typical* route bipolar travels is father to daughter to son, repeat.

In dh's family this is very true. Although it's my understanding that the females can show signs but not always have enough to need meds, they just pass it along.

So it goes like this: great-grandmother has it, then her son, passes to my mil--who can be quite stubborn but no dx, my dh, now we have a son with ASD and a daughter in preschool with nothing obvious yet.

Unfortunately as her story continued I could see how she was feeling responsible. I quickly told her that she didn’t know he had anything and they already had kids before his behavior got weird. Also we really don't have proof as to what caused ds's asd.

Anyway, you would think with dh's grandfather having dx bipolar, my husbands dx would be obvious, we'll it wasn't. Dh got in trouble all the time in elementary for impulse behavior, he was very stubborn, etc. He was dx with different things on different meds. It's difficult for him to talk about.

The good thing is you can treat it. I wish there was more than the million therapies ds does and actually something that would make him appear normal. His speech delay still makes life hard for all of us.

[theycallmemommy]

Also I do want to add that there is a hesitation to call it bipolar before puberty, at least when my dh was younger

[mrsbuttinski]

theycallmemommy,

I've seen this play out in my dad's family.

Great-grandfather who had 2 sons and a daughter. Came back from the Great War a heroine addict. Both his sons were addicts, daughter's sons were. Son #2's kids seemed spared those he was a hot mess. Son #1 begat one full-on bipolar with a subclinical son and dd who had bipolar with a son with a full-on presentation and a DD with a bipolar-type personality and a borderline son with a full on DD who produced a DD who is also full-on. My grandfather died when dad was 2, so no IRL influence.

[Deleted]

Neither parent has it. It is Great Grandparent and Great uncle on one side. Grandpa is an alcoholic.

And great uncle on other side.

[theycallmemommy]

Mrsbuttinski, that's a lot for one family to have.

Weirder still is that Dh has an older sister thats only a half sister with full on schizophrenia, began in her early 20s and she is not too much older than us and is on disability because her symptoms are just too much. She's not even blood related to the side of dh's family with the bipolar either-- it's his dad's side, not moms.

It's amazing how many things people can have medically going on. I have a very different perspective about life now. When someone is pregnant, I just hope for a healthy baby. Not that I didn’t before, but watching my husband manage his bipolar, go down the autism road with my son and see dh's sister go from "normal " to being on disability in her 40s, my heart just wishes for normal for everyone of my friends that waited until their 30s to start a baby. That's been about 5 people theven last few years

[theycallmemommy]

Waverly, just a shot in the dark here, but many with bipolar self medicate. The alcoholic might be an undiagnosed mood disorder. Not that I'm a doctor or anything LOL. One of the first things dh's new doctor asked him is if he had any addictions. He was surprised when my husband said he hardly ever drinks, no drugs, no gambling, etc. The bar for impulse control and self medicating is pretty low

[Deleted]

theycallmemommy, possibly. He says he as PTSD (veteran). So there maybe other issues- depression, mood disorder etc. He at once seems very practical but also like he is living in an alternate reality. The alternate reality is more recent- last 7 years or so. He lives far away, so not much we can do except be supportive over the phone.

[mrsbuttinski]

Dec 13, 2016 0:30:19 GMT -5 theycallmemommy said:

It's amazing how many things people can have medically going on. I have a very different perspective about life now. When someone is pregnant, I just hope for a healthy baby. Not that I didn’t before, but watching my husband manage his bipolar, go down the autism road with my son and see dh's sister go from "normal " to being on disability in her 40s, my heart just wishes for normal for everyone of my friends that waited until their 30s to start a baby. That's been about 5 people theven last few years

OMG yes.

When I moved my parents north from MD/FL, I had to replicate their doctors local to me. It meant chasing down records and finding a new PCP (both), Pulmonologist (both), Oncology Uro (him), Gastro (her), Orthopedic surgeon (her), Neurologist (him, she already has one local), Ophthalmologist (her), Cardiologist (her), and Dermatologist (both). Plus I added a psychiatrist and therapist for her last week because I had a couple days a month without appointments. FWIW, getting a psych who will see people over 75 is as difficult as finding one who sees children.

[akafred]

Dec 13, 2016 0:34:06 GMT -5 theycallmemommy said:

Waverly, just a shot in the dark here, but many with bipolar self medicate. The alcoholic might be an undiagnosed mood disorder. Not that I'm a doctor or anything LOL. One of the first things dh's new doctor asked him is if he had any addictions. He was surprised when my husband said he hardly ever drinks, no drugs, no gambling, etc. The bar for impulse control and self medicating is pretty low

Self medicating is very true (for many mental health issues), but the little boy and his dad also may not have bipolar. There are lots of other possible explanations for the behavior.

[mrsbuttinski]

Dec 12, 2016 16:04:51 GMT -5 @clarypax said:

I would say he has been struggling behaviorally since age 5 when his dad went to work and he started K. I don't think those things actually caused it just the timing.


That sounds kind of ODD-ish, but some presentations of ASD or bipolar can become more obvious around that age. With ASD one might see rigid behavior, stimming and/or special interests. 


Its more like a child tantrums when they are 3 or a little at 4. Then at 5 and 6 they start to use their words and grow out of it, and he did not. It was also cyclical.


Hmm, You might see this in the three I mentioned above. Sometimes cyclical has a logical antecedent- seasonal allergies, adjustment to new routines at school, less time for outdoor physical play in cold weather.


So he would have long periods of time where he was better, and now they are in a difficult cycle and he is not coming out of it. I think the fact that he seemed better stopped them from getting treatment sooner becuase they thought he was better, and didn't realize it was going to get worse again.

I hope they get some answers.