ADD/Anxiety/Bi-Polar 11 yr.old

[suzz651]

My daughter is eleven and suffers from anxiety and has been on Lexapro for about a year.  It seems to help her somewhat (I notice a change when she misses a day).  I have suspected that she may also have ADD, and last year her teacher evaluated her and she scored very high on the scale. Her pediatrician confirmed.  We have tried three medications, all of which produced intolerable side effects.  The last one kept her up for the entire night, making me suspicious about the ADD diagnosis.  Her teachers say she talks non-stop and will not focus in class.  She is extremely bright (in a G/T class), so she IS capable, but she is also lazy.  She has "breakdowns" because she is failing, the teachers yell at her, she feels embarrassed, etc.  She says she feels "like the missing piece of the puzzle".  She will have what we call "meltdowns" where she SCREAMS, throws things, knocks everything to the floor, etc. We have been to three therapists with unsuccessful results, and there aren't that many in my city.  Bi-polar runs in my family: grandfather, uncle, and I am on Depakote to regulate mood swings. I am told it is difficult to diagnose in a child.  I am at the end of my rope.  I have multiple medical problems and am in unbearable pain.  Her dad and I are divorced, and he wants to know nothing about her problems.We have MAJOR financial problems to boot.
How do I know if she truly has a problem or is simply lazy or both?  She says she desperately wants to succeed (her teacher has threatened to "kick her out of the program" where she will feel humiliated and her self-esteem will suffer), but won't do what is necessary TO be successful.  I she has to research for a report, she will go to twenty web sites rather than just choosing ONE.  PLEASE, do you have any advice for me?  I get such conflicting messages from her behavior.  I KNOW her anxiety and worries are real, she always talks about the "pressure" and how she can't take it.  

[althepal39]

My heart goes out to you and your child.  I am not a doctor -  but my opinion is that her major problem is anxiety.   If you think about it - and put yourself in her shoes - she is an 11 year old girl who is very bright - she has gone through a divorce (devastating to a child no matter what the circumstances), her father has rejected her, she sees her mother in unbearable pain, she sees her mother struggling with finances,  and she cannot concentrate in school, she is being yelled at and humiliated in school and feeling like she is letting everyone down if she doesn't do well - and she is on all this different medicine.. aaahhh!!  She is under a lot of pressure.  : (     Maybe you might want to try a more natural approach - not so much medication - maybe you could both try yoga, relaxation exercises, - this may help with your pain from your medical condition also - which may make her feel more relaxed. Maybe she could take a break from the gifted program for this year also.  If it is causing so much anxiety - is it really worth it?   After all you two have been through - maybe you need to just step back and really take care of yourselves and be good to yourselves for a while.  I wish you all the best.  

[Kevin Kennedy, Ph.D.]

The combination of the symptoms your daughter displays and the family history indicate that she may well be displaying Bipolar Disorder. If she indeed does display Bipolar Disorder, psychostimulant medication could well exacerbate her instability. It would be prudent to arrange a second opinion consult to consider this, or broach the matter with her current providers. The fact that she has not yet been helped by the treatments for ADHD does not itself indicate that the diagnosis is inaccurate, but I would certainly wonder about it.

[jdtm]

I belong to a support group for teachers and parents of children suffering from anxiety.  What we have found to be true in many of our children is their inability to learn easily in a "perceived" unsafe environment.  Your daughter appears to fit this scenario - her words "she can't take it".  Many of our children have been diagnosed with ADD and/or ADHD; which most of us think is incorrect due to the stress and anxiety issues our children feel.  Also, many of our children have been diagnosed with expressive/receptive disorder which most of us think is also incorrect for the same reasons as above.  Our children are not hyperactive or deficient in attention or unable to comprehend/speak language when they are not stressed.  The research in this area in North America is beginning to show that our beliefs probably are correct.

I expect your daughter is capable of doing well at school when she feels safe and comfortable.  Unfortunately, most of our children never feel safe and comfortable at school and so they tend to have lower marks and comprehension than would be the case if anxieties were not present.  Anxiety is an "invisible disorder" and because the teacher cannot see the deficiencies, our children are often blamed for behaviours they cannot control.  Meltdowns are common when their distress reaches toxic levels - I wonder if the dose of the medication is correct or should your daughter be taking her meds at another time of day or perhaps even change medication.  Maybe she might need therapy and/or intervention; however, remember anxiety is "managed"; not cured nor outgrown.

I doubt at this point that your daughter is able to do what is necessary to be successful due to her high stress/cortisol levels.  Perhaps she needs a break from the G/T class, or sometimes she needs to work in a quiet space as the library or separate area in the classroom, or her teacher needs to "back off".  Our child is just starting to learn easier in school - this is her ninth year - it takes years of patience and understanding.  

It's not fair - a very bright child having difficulty learning in school but this is one of the  burdens of anxiety.  There are books and sites on the internet that can help the teacher and parent in working with our children; perhaps even your doctor could speak to the school.  I hope I have been of some help.