New to board, need help with Dr. | ADHD Information

Smallmom, be interesting to see if they change the adult bipolar II to that name. Makes sense since, although similiar, the two disorders have enough differences to sit up and take notice. Heck of a lot easier than bipolar 1, 2, 3, 4, etc. etc. etc.  

Celebrate ADHD,

THank you for your positive response. :)

Yes, homeschooling was/is a wonderful option for our DS. We watched his personality change so drastically in kindergarten and then 1st grade. His self esteem seemed to be vanishing before our eyes. So, within the first month of 2nd (as the tears and phone calls resumed) we pulled him from school and began this homeschooling journey. :) It's bumpy, to say the least, but less bumpy than public school was. Not to mention we're getting better at it as we go. :)

I think that is the reason that I'm not as worried about the lack of focus right now. We are able to design his curriculum around his interests and body clock and he's learning just fine. It takes some juggling and a LOT of creativity but we're managing.

It's his irritability and overall anger that is keeping me up at night. My husband and I are starting to feel hopeless to help him in this area. :( I guess I just need to lay it all out like this for the doctor and if she responds negatively, I guess I'll start the hunt for doc #3!!! We're moving out of state in a little over a month so we'd have had to find a new doctor anyway. ;) I just seem to walk into the office and feel like I'm a kid in a principal's office!  That's why I'm asking for help. I need a "script" to read from in case I lose my nerve with the Dr.

Thanks again.

Jamie

SmallMom and Oldermom,

   THanks for the insight! :) Yes, I think you're both right about getting another opinion if this doc doesn't seem open to other possibilities. I just hate that when we finally decided to ask for help with DS that it seems to darn tricky to find the RIGHT help! Ya know? ;)

  I've never even heard of SMD, but plan on really looking into that. THanks!

 

ALso, we're seeing a child psychologist now. WHere/how would I find a good Neuropsych?

THIS is why I came out of lurking and posted. You ladies are GREAT! :)

I agree with getting an accurate dx..... you might want to check out the Alternative to Meds board.  Omegas are great mood stabilizers and can usually be taken in conjunction with meds (always good to check w/ doc first!).  It might be that a combination approach might work well for your son.  If you are interested, the thread is entitled "Omegas Latest Research".  Welcome to the board!

Neuropsychologists can be found at university and children's hospitals.  They do hours of testing to assess what's going on.

I hadn't heard about SMD either -- until I heard Dr. Leibenluft speak recently and then our pdoc mentioned it yesterday.

Good luck!

Hi Jamie,

You have good instincts, so always trust your instincts as a Mom! I agree that "focus" for an 8-year-old boy is not the primary issue that needs to be resolved. Little boys are supposed to be curious and adventurous and filled with energy. Since you homeschool, you have an opportunity to create experiential, hands-on lessons outside and at museums. Use experiences to teach life lessons.

Confidence and peace are the primary qualities we need to preserve in our young children. Often times, the anger and outbursts are caused by frustration at being forced to be like everyone else. Our kids are wired differently--so we shouldn't be afraid to reach and teach them differently. So work WITH his nature, not against it.

Find ways that he learns best. If he likes to stand or pace or do something active while learning, then go with that. Recent research proves that boys learn more effectively when they are active. So kick a ball back and forth or lie on the grass looking up at the clouds while you teach lessons.

You are right to be wary of doctors that take the easy way out--just handing you a prescription without giving you positive, proactive ways to help your child is a cop out.

Our advice is this: before you try to change your child through medication, try to change everything else around him--your attitude, your home environment, his diet, the way you reach him and teach him. There are dozens of practical ways to work with your son's nature instead of against it.

I'm a broken record on this, but it's really important to relax and create a positive environment. Catch your son doing good things. Give more energy to good behavior than inappropriate. And take time to enjoy your son and his unique gifts, talents and passions.

Peace and blessings to you.

Hi Jamie, I'm glad you found your way here.  I'm someone (among several other moms here) who have BTDT.  I have two children who have working dxes of bipolar disorder.  My 12-year-old son's first dx was ADHD and anxiety 3 years ago.  Unlike your son, he did OK on stimulants, but when he entered middle school (6th grade last year), his mood issues seemed to take over.  When we tried to medicate his anxiety with an SSRI (Zoloft) last fall, he had a manic reaction that led us down the bipolar path.  He is now on the mood stabilizers Depakote and Lamictal and improving slowly, but we're not out of the woods yet.

In my opinion, your first step is to get an accurate dx.  I agree -- a checklist does not a dx make.  There are a lot of ADHD mimickers out there, including bipolar and high-functioning autism.  So I suggest you tell this psychiatrist you're not comfortable with a quick dx and see what she says.  If she doesn't listen to your concerns, I would recommend getting a second opinion with a board-certified child psychiatrist who has experience treating kids with mood disorders.  And I would also recommend an evaluation with a neuropsychologist, who can assess for many childhood disorders, including but not limited to ADHD.

I've recently learned that researchers at NIMH (led by Ellen Leibenluft -- do a google search) are doing research on a syndrome they've coined "Severe Mood and Behavioral Dysregulation" (SMD).  Most of the time, kids with SMD are depressd, irritable and easily frustrated.  They differ from kids with bipolar who have distinct episodes of extreme happiness, decreased need for sleep and increased activity level.  The researchers are trying to determine if kids with SMD respond to the same treatment as kids with bipolar.  My 11-year-old daughter's pdoc believes she may actually have SMD instead of classic bipolar, whereas my son's pdoc thinks he has bipolar.  In any event, your description of your son made me think of SMD.  

Please post again with other questions.  You are not alone -- we're here for you.

 

I would take him for another opinion. Some doctors see other disorders, but are loathe to diagnose them and try stimulants first, although, since all stims are basically alike, a bad reaction to stims generally points to other things besides ADHD. I recommend seeing a NeuroPsych or a different Psychiatrist (with the MD) and not depending on a Psycologist (without an MD) for diagnosis. Does this child rage? I wouldn't medicate my child until I felt comfortable with the diagnosis. ADHD has many mimickers and many kids are wrong medicated for it. My son was one. Good luck.''

Smallmom, that SMD (I never heard of it before) sounds a lot like Bipolar II in adults--mostly depression, but some hypomania. This is what I have. As a child I had the symptoms of bipolar, but less severe. I'd only rage maybe once a month as opposed to every day. I'm always amazed when I hear that some kids rage daily and I feel so badly for them. I can't even imagine. 

OlderMom38801.7675115741

Hi. I'm new to this forum and would really appreciate some BTDT advice.

DS is 8. Has been a handful since toddlerhood. My husband and I dealt with him really well until he turned 6. It seems once school began everything has become so much worse. :( WHat used to just be endless energy/ideas/movement etc has turned to extreme irritability, low self esteem and a general sense of conflict in our home.

We took him to a Psychologist first. He said ODD and Short term memory deficient. Offered ZERO help beyond the DX, even said we "didn't need to come back anymore". No advice, no guidance, not even a flipping pamphlet!

We go for a 2nd opinion with a Child Psychiatrist. She DX'd him ADHD the first visit. SHe based her diagnosis off of the standard ADHD checklist. DS showed all but one symptom. We left her office with a prescription in hand. I didn't like the "rush" to meds feeling, but at this point I was desperate to try anything.

We tried Focalin XR (5, and 10mg). Helped him calm down a bit, he could focus better on school lessons but he seemed more emotional than usual.

Next we tried Adderall XR (5, 10, 15 and then 20mg). This really seemed to help his focus and his ability to stay on task but he was SOOOOOOO angry and irritable. He was yelling at least 15X a day and we were all walking on eggshells around him.

So, he didn't go more than a month on either med.

Now, we have another appointment with the psychiatrist this week. I need some guidance on how to talk with her about my concerns. My #1 issue with DS is his irritability. Periodically throughout the day he can just get so angry. He's never violent towards others, but he yells, stomps and has even hit himself occassionally. It seems provoked by small things (usually involving his little sister). Other times he's just his old self with boundless energy and a grin on his face. It seems nothing I do can keep him steady over the course of the day. The doctor seems most concerned with his inability to stay focused on schoolwork etc (which I agree *is* a problem), but I'd like her to be more focused on the temper issues as those are the ones really taking a toll on my family. :(

I'm not even sure if ADHD is the right DX. It very well may be, but I'm so terrified of experimenting with ADHD meds for a year only to find out later that it's not ADHD!!!!! So, any advice on the best way to make my concerns known? SHould I mention my fear that it could be early onset Bipolar? What should my response be if she seems resistant to my suggestions?

THis got rather long, so thank you if you made it all the way through. :) I'm just feeling so confused and burnt out lately. I feel the weight of this falling squarely on my shoulders ( we homeschool so I'm with him a LOT!). I have no friends/family in a similar situation so I feel a little alone. Thanks for any help you can give me! :)

 

Jamie

When you go see the new pdoc, I recommend asking what testing they are equipped to do and whether they will do observation.  This is a toughie because the time of a pdoc is expensive, but without good testing (more than a checklist and parent questionairre) and/or observation it is unlikely you will get more than a quickie diagnosis.  My DS's pdoc did not do observation, but we did evaluations for ADHD, bipolar, clinical depression and ODD before we got our diagnosis.

Now would also be a great time to start on some counseling for your DS, especially with the anger issues.  If your pdoc works in a practice that has LPCs you could start out with one of those for counseling and since they would probably have more interaction with your DS, they would be in a better position to make recommendations on treatment/accommodations you can make.

As far as the anger goes, there are a lot of ADHD mimicers out there, but don't forget that ADHD rarely travels alone.  Frequently it is comorbid with another disorder like depression.  My DS is only 6 and sounds quite a bit like yours.  He is ADHD - Impulsive type with comorbid depression.  When we began treating the ADHD, a lot of his depression (which was mostly expressed through frustration, anger and moodiness) was resolved, but there was still a bit left over.  We are now supplementing with wellbutrin (lowest possible dose) that has really helped.  According to our family MD, wellbutrin is also being used offlabel to treat adult ADD (and it's what my DH takes for his becuase it helps him focus).

Best of luck, and remember that you know your child best and are his best advocate.  If something does not seem right, speak up, if you are not listened to, walk out. :)

 

BTDT -

Like SmallMom, my son had a dx of ADHD/ODD for almost 5 years. We've been through 6 psychiatrists in 6 years. He's been on every ADHD medication that I think they can give.

I can't tell you if your son has early onset Bipolar or not - but I can tell you what I saw with Dylan that made me and the current pdoc (who, let me say, I love with all my heart and soul) know it was not ADHD, but Bipolar.

Temper tantrums/rages/meltdowns lasting anywhere from 15 minutes to 3 hours.

The inability to have any control over any of his emotions. If he was angry, it was a meltdown. If he was frustrated, it was a meltdown. If he was upset, it was a meltdown. Everything, I mean EVERYTHING, made him rage. He clearly had no control over it.

Mood swings/mania. Although I have not seen the depressive side of Dylan, ever, he has been in, what I consider, a euphoric state. Dancing around the house, arms out like a fairy. Standing on the furniture singing at the top of his lungs. So incredibly UP - totally not normal for a 9 year old. He is also now displaying some anxiety issues (baby behaviors that we are seeing now that the rages have stopped with the Lithium).

The fact that NONE of the stimulants worked. They all over-stimulated him. This includes the atypical antipsychotics as well (Risperdal, Abilify, Seroquel). We gave him a small dose (.25 mg a day) of Risperdal in December of 2005 and he was caught on all fours in the classroom, barking like a dog (nobody was around but the teacher). He was also caught standing in the corner asking the wall "are you drunk?". Talking aimlessly, to whoever, or nobody. Needless to say, didn't work.

I'm going to say, the medication trail is a tough one when you have a child that is out of control. I know you probably don't want to hear that, but sometimes it does take alot of trial and error to get the right mix - or even the right one pill. The stimulants are supposed to work within 24-48 hours, so if you're not seeing results right away, that should trigger a light bulb something is not right, especially where you've already tried quite a few.

I have to agree with the others too, if pdoc is not willing to listen to your concerns, I would get a 2nd opinion. The neuropsychologist is also an excellent idea. We are in the process of doing these exams now (to rule out or confirm the PDD dx).

Hope you're able to figure this out. Good luck.

OlderMom, you're right -- SMD and BP II sound a lot alike.  However, what the researchers are discovering is that kids with SMD go on to have depression as adults and kids with classic BP symptoms (narrowly defined) go on to have BP as adults.  They are also finding that the functional MRIs are different for each group.  Very interesting research.