Pediatric Bipolar / ADHD / ODD

[ajs67]

Over the past several weeks since Brandon’s medications have been lowered he has become much more difficult to deal with at home, school, and with peers.  He refuses to do homework, schoolwork, will only eat specific foods, will not stop annoying habits, does rude things, says things to his brother like I will cut you with this pocket knife when he his mad at him but has never acted on it, and has no respect for authority just laughs at authority figures when being asked to behave or do something.  We are not sure what to do?

My son Brandon has learning disabilities, behavioral difficulties that we noticed when he was starting kindergarten which we had him repeat twice, and then it became very apparent that something was different.  He is now eight years old, and for the past years he has been through a lot with his previous pre-school and kindergarten teachers setting him aside because he was just not the norm and required one on one attention and extra help, which damaged his self-esteem, his nature, and I believe adding to his separation-anxiety and depression.  He has had two positive years in the Folsom Carl Sundahl School system with great teachers, and a special additional for two years in a row for an hour after school each day for one on one reading and math assistance and they have brought him a long way in the past couple of years, yet he is still is just approaching grade level which is very frustrating for him, and his school comes very easy for his younger brother who is only 13 months younger then him.

Background:
Diagnosis:  ADHD/ODD, Anxiety, Depression, Bipolar II, Learning Disability
 Separation Anxiety, Deep depression – up and down (swings), eyelash pulling and pulling out hair without anti-depressant, it took 150mg of Zoloft to finally stop the habits and put a smile on his face.
 Does not feel pain like other children – can run across rock beach with no shoes and feels nothing - no pain.  Loves animals can get stung by bees and does not care.
 Cannot focus in school, difficult for Brandon to concentrate or for teachers to get quality time with him
 Tries to manipulate teachers by telling them stories and get them off the subject so that he can get out of doing the work he does not like
 Rude to others, more disrespectful than normal, blurts out rude comments to people – does not think before speaking
 Refuses to perform at Bright Futures Learning Classes and sits idle during his one on one session for private tutor lessons
 Does crazy things like swallows objects that are dangerous – things that he has never done before…. When on ADHD medications
 Abnormal climbing walls, and furniture, abnormal walks away from home to ponds to find animals and lizards without telling us where he is going… not normal behavior… when on ADHD medications – this is why pediatrician – Dr. Arab referred Brandon to Dr. Clopton
 Outbursts rude statements to adult authorities –
 teachers, neighbors, parents, waiters, etc. without any concern
 for their feelings
 Does not respect authority – he says the only ones with authority are police because they have guns
 He talks about death with high interest and enthusiasm and wants to know details of stories on the news etc.
 When he finds a dead animal he wants to examine it but we have tried to teach him that the best thing for the animal is to bury it
 Very particular about foods and will not eat unless he gets what he has programmed his mind to eat….. for the given meal very stubborn

Interests:
 Lizards, animals, and always trying to get another animal as a reward in exchange for doing something.
 Fishing, Wandering in open country free of inhabitance
 Religion – Jewish, Hebrew School
 Keeping thin…
 His little brother and baby sister – he does love them very much – even if he beats the pulp out of his little brother from time to time!

His medications were as follows as of 1/18/08 and prior for at least 6-months:
DEPAKOTE ER 500MG TAB TWO TIMES DAILY
ZOLOFT / SERTRALINE 100MG (1 ½ TABS) EACH MORNING CLONIDINE HCL 0.2MG (1 TABLET 30 MINUTES PRIOR TO BEDTIME)

His Psychiatrist had him on  the following and added Abilify, Then, on 1/19/08, his Doctor changed the medication as follows which caused a problem Dystonic Reaction and he ended up in the Pediatric ICU two days later from the Abilify.
DEPAKOTE ER 1000MG (BEDTIME)
ZOLOFT / SERTRALINE 100MG (1 ½ TABS) EACH MORNING CLONIDINE HCL 0.2MG (1 TABLET 30 MINUTES PRIOR TO BEDTIME) ABILIFY 10MG (1 TABLET EACH MORNING)


Discharge instructions from Sutter Memorial from Dr. Chretien and during his first appointment with Dr. Chretien on Feb. 7, 2008, medication dosages were kept same for now:
DEPAKOTE ER 500MG (Bedtime)
ZOLOFT / SERTRALINE 100MG (Morning)
CLONIDINE HCL 0.2MG (1 TABLET 30 MINUTES PRIOR TO BEDTIME)

On appointment Thursday, February 14, 2008, during Brandon’s first appointment with his new Psychiatrist, Dr. Ted Hoffman, after discussing background and my personal diagnosis as a parent from the reading that I have done (Bipolar Disorder Type Two, Attention Deficit Hyperactivity Disorder, Learning Disabled, Anxiety, and Oppositional Defiant Disorder).  Dr. Hoffman said that it was unfortunate that Brandon responded poorly to Abilify because the dopamine is what he needs for his condition, but since this caused a Dystonic Reaction he will have to work around this with different medications.  Dr. Hoffman decided to change medications as follows and to see Brandon back in three weeks:
DEPAKOTE ER 250MG (Morning and Afternoon)
ZOLOFT / SERTRALINE 50MG (Morning and Afternoon)
CLONIDINE HCL 0.1MG (1 Tablet in Afternoon), and (2 TABLET 30 MINUTES PRIOR TO BEDTIME)
Results:  Drowsy - no focus, motivation, attention benefits, and he is beginning to pick his finger nails now.

[Sandman2]

     Opps, sorry I forgot that the link was a private message to me.  Here is a copy of what it says:
    This is a list of the differences between ADHD and Bipolar because they are very similar:



1. Destructiveness may be seen in both disorders but differs in origin. Children who are ADHD often break things carelessly while playing (“non-angry destructiveness”), whereas the major destructiveness of children who are bipolar is not a result of carelessness but tends to occur in anger. Children who are bipolar may exhibit severe temper tantrums during which they release manic quantities of physical and emotional energy, sometimes with violence and physical property destruction. They may even exhibit openly sadistic impulses.
2. The duration and intensity of physical outbursts and temper tantrums differs in the two disorders. Children who are ADHD usually calm down in twenty to thirty minutes, whereas children who are bipolar may continue to feel and act angry for up to four hours.
3. The degree of “regression” during angry episodes is typically more severe for children who are bipolar. It is rare to see an angry child who is ADHD display disorganized thinking, language, and body position, all of which may be seen in angry bipolar children during a tantrum. Children who are bipolar may also lose memory of the tantrum.
4. The “trigger” for temper tantrums is also different. Children who have ADHD are typically triggered by sensory and emotional over stimulation, whereas children who have bipolar disorder typically react to limit-setting, such as a parental “no.”
5. Disturbances during sleep in children with bipolar disorder include severe nightmares or night terrors often with themes of explicit gore and bodily mutilation.
6. Children who are bipolar often show giftedness in certain cognitive functions, especially verbal and artistic skills (perhaps with verbal precocity and punning by age two to three years).
7. The misbehavior in children with ADHD is often accidental and usually caused by oblivious inattention, whereas children with bipolar disorders intentionally provoke or misbehave. Some bipolar children are described as “the bully on the playground.”
8. The child with ADHD may engage in behavior that can lead to harmful consequences without being aware of the danger, whereas the child with bipolar disorder is risk seeking.
9. Bipolar children tend to have a strong early sexual interest and behavior.
10. Children with ADHD usually do not exhibit psychotic symptoms or reveal a loss of contact with reality, whereas children with bipolar disorder may exhibit gross distortions in the perception of reality or in the interpretation of emotional events.

There are 3 levels of bipolar. Bipolar I, Bipolar II, and Cyclothymia. Lithium is usually used to treat bipolar because it treats depression and mania but it cannot be given to a child under 12. I have never used drugs. If a child is hyper I use the adkins diet as it will bring a hyper person down within a week. Pure protein and dairy. The will be lethargic by week 2 but I usually keep it going for a month. Stimulants are good for treating depression. Its only dangerous for mania because when a person is in mania they are secreting large amounts of adrenaline and endorpines and they are stimulants. When a stimulant is added you get kids that can't ever sleep and they will develop psychotic symptoms quick.
Oh BTW let parents know that even if its ADHD or bipolar any cough syrup or flu medication over the counter will triple symptoms. All of them state under warnings do not use if you have a psychiatric condition. I use thyme to treat sinus congestion, hey fever and sore throat. Oregano is a heavy seditive and sometimes I use chamomile teas.

[moviestardude99]

the link did not work and yeah if you could find more info about please send it to me thanks

[Sandman2]

  I left this for you on the child behavior forum.  But here it is again.  Its pretty good showing the differences in childhood, but I think it also applies as you get older.  I'll look for more stuff.  Let me know if this helps.
          I can't vouch for the accuracy of these statements, but many of them do correlate with other things I have read.  This is a post from a person with experience in both worlds.  Let me know how you feel about it.
   The link is - http://www.medhelp.org/private_messages/show/1075639
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[moviestardude99]

So am I bipolar?

[moviestardude99]

Thanks I know some about it but send me the link please I am very frustrated by it. I go to one of the best schools in the world (it is located in Texas) I have had my whole life. I would like meds for it or get help for it its just parents don't want to and the neurologist is like completely does not know what to do or think why i do this. I take focus meds but it.....

[Sandman2]

   I read your comments in the teen health community.  A lot of those things are somewhat common for someone who has ADHD and is extremely frustrated by that condition.   How much do you know about ADHD and how it effects you?  Unfortunately, Texas is not the greatest state for getting help in the schools.  How long ago did you find out you had it?  Ever go on meds or get behavioral modification help?  I've got some sites that may be helpful for you if you are interested.  Let me know.   Best wishes.

[moviestardude99]

so i have add, adhd and i dont know if I am bipolar and i want to know and i need to know what i need to do and my nero does not know what to do and basically gave up on me

[psychdoc551]

I meant to say omit, not admit, in #8.  It's late and I'm tired.  Best of luck to you.  

[psychdoc551]

My heart goes out to you.  I am a child psychologist, with expertise in differential diagnosis.  If it were my son, or if you were my patient, I would absolutely recommend that you do the following:

1) Start your son in weekly or twice weekly psychotherapy with a well-known licensed clinical psychologist right away, and plan to meet with the psychologist weekly on your own, to discuss your son's progress and treatment, and to obtain assistance with parenting him. It's unhelpful to treat emotional/behavioral problems, even those with a neurobiological basis, with medication only.  Combined medication and intensive psychotherapy is strongly advised.  If your doctor tells you that psychotherapy is not necessary, run for the hills and find another physician fast; someone who supports the combined approach. Check out the PBS Frontline presentation The Medicated Child.  If nothing else, it will be eye opening.
2) I would be extremely cautious in giving your son antipsychotic medication (i.e. seroquel, Abilify, Risperdal, Geodon), even though it has become quite common to prescribe these medications to young children. The FDA has not approved most antipsychotics for the treatment of Bipolar Disorder in children.  Find out which meds have been approved for the treatment of specific disorders, and get a second opinion. Also, please be advised that there is only clinical support for the diagnosis of early onset Bipolar Disorder.  The American Psychological and Psychiatric Associations have not yet formally recognized Bipolar Disorder as a childhood disorder. Know that the experts disagree as to whether childhood onset Bipolar Disorder even exists.
3) Does your child have an Individualized Education Plan?  Either way, go to wrightslaw.com and find out your rights as a parent of a child with special needs.  He needs you to advocate for him in the school setting.
4) Get an independent educational evaluation. Go to the state board of education website in your state and you'll be able to find a list of approved evaluators who can test your child, and accurately diagnose the nature of his learning disabilities.
5) Has your son had a 24 or 48 hour EEG?  What about an MRI? You should take him to see a pediatric neurologist to rule out a possible seizure disorder or structural abnormality.
6) Get an Occupational Therapy evaluation done, privately. It sounds like he has sensory integration problems (heightened tolerance to pain, movement seeking, and general dysregulation).
7) The mother of one of my patients with ADHD began following the Feinstein diet, and she is reporting some positive results. It might be worth checking into it.
8) Please do not admit any of these steps.  Do them all.  You won't regret it.  

I hope this was helpful.