Daughter with extreme outbursts

[whitney6494]

Hi everyone,
I'm trying to deal with and diagnose my daughter who has no patience,extreme violent outbursts and has trouble at school. The medication that she takes has helped a little but has caused her to put on some major weight. They say she has a little ADD some bipolar characteristics. She is such a loving caring girl when she's happy but then just snaps and gets very aggresive. Just wondering if anyone else is dealing with something similar and can tell me what they are doing or have done to make thing a little easier.

 

[Nature Mom]

My DD10 was diagnosed with ADHD and a learning disorder in 1st grade, as well as a gluten allergy, but about 1-1 1/2 years ago she started going crazy with temper tantrums and had gained a huge amount of weight as well from the ADHD meds. She was finally officially diagnosed as bipolar late last year. So far it has been an unbelievable rollercoaster ride, and it is so hard, I totally get where you are coming from. Sometimes I think God maybe is trusting me a little too much on this one. : It isn't that she is a bad kid at all. Her sweetness and compassion is touching to everyone , her comedic wit and artistic talents are amazing , she is just unbalanced . We are on a new medicine combo now and balance is being restored, although it is often 1 step forward, 3 steps back. Check out www.bpkids.org and look around. You may find some answers. I will say prayers for you all. My main advice is get her to a doctor. You may have to go through your pediatrician to get a referral, but ultimately find a good ped. psych doc. Good luck, namaste.

 

[Maggie'sMom]

I'm a single mom to a 7yo DD who is bipolar. We started working with a psychologist just after she turned 4 and we got the diagnosis when she was 5.5yo. She is very similar to your and Nature Mom's DDs: loving, caring, sweet, funny, and so on when she is stable. But when she's not stable, it's horrible.

By your comment about her gaining weight on meds, it sounds like she is on an antipsychotic (Risperdal, Seraquel, Abilify) since weight gain is a significant side effect of those meds. If that's not the case and she is on a traditional stimulant ADHD med, you need to talk to her psychiatrist about getting her off that. ADHD stimulants are not a good course of action for a person with bipolar. They can significantly worsen the aggression and manic symptoms. If you are not working with a pediatric psychiatrist, then you need to find one as soon as possible. Early onset bipolar is extremely difficult to treat and is very different from adult onset. You need someone with a lot of experience treating children with this.

If you haven't already, I'd recommend you read "Raising a Moody Child" by Mary Fristad (I probably have the spelling on her last name wrong). I'd also recommend reading "The Explosive Child". Although it isn't entirely about bipolar disorder, the technique the author presents in the book is very helpful with bipolar children.

DD initially had a lot of success on Abilify, but then it stopped working for her. We tried (at various times, not all at once) Lamictal, Tenex, and Intuniv (extended release version of Tenex) combined with the Abilify. But we couldn't get her back to stability. We are now switching her over to Seraquel and are seeing some improvement, but still having some problems.

My heart goes out to you. It's so difficult watching our children suffer like they do.

 

[bookwormde]

If she has some indications of social skills deficits and/or any sensory differentials, then with the EF indications it is time for a full evaluation. What you describe is classic for kids who are Aspergers or aspies and are not properly clinically diagnosed and supported and a put on medications for behavioral symptoms instead of finding the source of the issues.
There can be other environmental causes such as PTSD and primary anxiety, but they much less common than the genetic side.
Be aware that Psychiatrist have virtually no competency in this area and do major damage to kids due to this (less than 5% have taken the time to learn about this area of neurology). find a really good pediatric neurologist or developmental pediatrician who can refer you to a major medical center or group which is highly regarded in this area.
Here is a link to see if any of the pieces fit and if you get any indication, get a copy of Tony Attwood's "The Complete Guide to Aspergers" which is available on Amazon for about $17 and read it.
http://help4aspergers.com/index.html
Girls are much harder to diagnose that boys since they tend to be good at mimicking and actress skills so it takes a highly qualified clinician to pick up the subtleties.
It may be that she only has a few pieces and will not qualify for a formal diagnosis, but unrecognized these can still bring about the secondary diagnosis you describe.
The prognosis for treating symptoms which are maladaptive manifestations of an underlying undiagnosed cause is not good in the long run so avoid the common mistake of chasing symptoms and get to the route cause. Primarily diagnosis of mental illness is actually quite rare if children are fully screened to ruled out underlying causes and other primarily diagnosis.

The good news is if you can get the cause and address and support the things you are seeing diminish very rapidly. It is sad that these kids often suffer for a long time before they happen upon a clinician with the competency to help them

bookwormde

 

[Maggie'sMom]

I thought of a couple other things after I posted last night.

1) Do your DD's moods have a seasonal component? Do you see them getting more intense during fall or spring? My DD has a significant downturn every fall as the days get shorter. The depressive phase really takes hold. We started using a light box last fall to counteract this. I notice a difference with it. A lot of parents of bipolar kids will notice an increase in manic behaviors in the spring as the days get longer.

2) Depending on what study you look at, between 50% and 90% of bipolar children will have comorbid ADHD. In these cases, it's important to get her mood stabilized before trying to treat the ADHD symptoms.

3) You may want to have her evaluated for sensory difficulties.

 

[Nature Mom]

I thought of a couple other things after I posted last night.

1) Do your DD's moods have a seasonal component? Do you see them getting more intense during fall or spring? My DD has a significant downturn every fall as the days get shorter. The depressive phase really takes hold. We started using a light box last fall to counteract this. I notice a difference with it. A lot of parents of bipolar kids will notice an increase in manic behaviors in the spring as the days get longer.

2) Depending on what study you look at, between 50% and 90% of bipolar children will have comorbid ADHD. In these cases, it's important to get her mood stabilized before trying to treat the ADHD symptoms.

3) You may want to have her evaluated for sensory difficulties.

Agree with Maggie'sMom: Many bipolar people are affected by the seasons, thus adding Seasonal Affective Disorder to the laundry list of issues, but light therapy works great and get her outside as much as possible when weather is appropriate. Also, outdoor exercise is like a triple whammy for me: 1. She is getting some sunlight; 2. she is exercising and pumping up her endorphins which seem to be so much more stabilizing than meds as well as good mood inducers; and 3. she's distracted. I am lucky enough to live near several areas that have great walking paths near rivers, streams, nature centers, etc. and if I see her come off the bus with that look (and you know the one), I immediately throw plan B into action and we head out the door to give her quiet, outdoor stimulation (and I alway have a small snack bag ready, just throw in cool drinks). Homework can wait, it won't happen anyway if there is a meltdown so avoid, avoid, avoid the drama and redirect the energy.

Another great book is The Bipolar Child by Demitri Papalos, M.D. They have it at Amazon but our psych doctor gave us a copy, and it isn't a cheap book either, nice hardcover edition. Very good info in there.

Also agree on M'sM on the comorbid ADHD. Our psych will not let DD be on ANY ADHD meds until all her bipolar meds are adjusted and working correctly. This did cause an issue with one of her teachers (and myself) in the beginning, but I see what he means now and am willing to let him get the main problem worked out first and then we will retackle the ADHD issues.

My DD has sensory issues, too. Teeth brushing is a BIG deal as well as how her blankets are on her when she goes to sleep; she says her ears 'hear too much'. They can vary from child to child, but it is possible your DD is VERY overstimulated and her senses are too in-tune. KWIM?

Hope all this helps, you can always message me. And always remember, pick your battles. With a BP kid what we may think is just a tiny little thing we ask them to do can be the catalyst to set them into a rage. Ask yourself, is it worth a rage? Can it wait until her mood is more stable and we can talk? BP kids cycle much faster than BP adults, you can often see a child cycle many times in one day. Learn your child's cycles, start keeping a notebook. It will be very helpful when you go to the doctor and you can pinpoint dates and times of rages, exuberance, giddiness, crankiness, anger, depression, clingy-ness, etc. (And yes, many kids go through these emotions, BP kids just go through them nonstop.)

 

[SueM in MN]

Since this is not about WDW, I am going to move this to the disABILITIES COMMUNITY Board where it will be on topic.

 

[whitney6494]

Thankyou all for all of your kind words and help. We are working with doctor and just trying different meds. As they fail we move on to the next. Right now Intuniv was working for a while and he just added Abilify. It's only been 3 days but she seems very on edge and even the smallest of things is setting her off into a major outburst. We will be visting her psychologist tomorrow to give him an update on how she's doing with the Abilify. She seems to be eating less on it so thats a plus. The lexapro she was on made her gain 25 lbs over the summer. We fought about her eating all summer long.
As you all stated...I also have a very loving, super sweet,caring and hilarious DD. When things are good they are soo good and I get a taste of how things could be. But when things are bad for her they are REALLY bad and the whole family is suffering. I repeat to my DS4 that DD has trouble controlling herself but he can't act like that. Because I know he's fine and can control himself. Just put in that atmosphere he has learned yelling and throwing a fit. I'm plugging along...I hope for some good news soon. Thanks for the meds advice!!!!

 

[whitney6494]

OH, I had never heard of the seasonal disorder going with BP. Good to know. I'll have to keep an eye on her. She's not outside nearly as much the past couple of weeks.

 

[Maggie'sMom]

Right now Intuniv was working for a while and he just added Abilify. It's only been 3 days but she seems very on edge and even the smallest of things is setting her off into a major outburst.

Every child reacts to medications differently so don't worry about this. But DD had a paradoxical reaction to the Intuniv. It was added to her Abilify to help her control impulsivity and aggression. I pulled her off it after 10 days because she was just going from one rage to the next. The last day she was on it she raged almost nonstop from the time she got up in the morning to the time I finally got her back to sleep that night. She would never completely calm from one rage before the next one started. It was over July 4th weekend and we were out of town at my parents' house. I couldn't get ahold of her psychiatrist or the psychiatric nurse practioner so I made the decision myself to stop the Intuniv. The rages subsided by the next day.

 

[GraceLuvsWDW]

My dd7 has very extreme reactions to meds. The only times she was severely aggressive and violent were on meds. When she is off meds she has periods where we go through rough times where she is hyper sensitive, aggressive, and reactive. I changed her diet and set up a strict routine and that has greatly reduced her aggressive reactions. We still have mood swings, and I am getting better and figuring out what sets them off. Many times it is sensory in nature or build up of anxiety.

Things were so bad at the beginning of the summer I seriously thought I was going to have to put her on Bipolar meds-as her Dev Pedi was strongly leaning toward BP. I did read the above book mentioned, the Biopolar Child and also Bipolar kids. the thing is all of these disorders are similar so it's practically impossible to know where the ASD, OCD, BPD, SPD end and another begins. It's very frustrating!

I guess I just wanted to offer that dietary changes have made a great difference for us, as well as going off all meds (did you know some meds actually WORSEN or bring on comorbids such as OCD or BPD?), and having a strict schedule.

 

[Karalynn]

Hello! I am going to hijac your thread, sorry!! What type of diet modifications have worked? I will try and post my own thread later, I am of lately, feeling very alone in all the issues my dd has, but as I read here I know I'm not!

 

[Nature Mom]

Hello! I am going to hijac your thread, sorry!! What type of diet modifications have worked? I will try and post my own thread later, I am of lately, feeling very alone in all the issues my dd has, but as I read here I know I'm not!

I know this wasn't directed at me, but we are on a gluten-free diet and switching to that made a huge difference. Although, DD did test positive for Celiac so we didn't have a choice, but I have heard others say it worked for them as well without needing it for allergy reasons.

 

[CMHusband]

How old is your daughter? I have an 11 year old son who was recently diagnosed with Aspbergers but it took years (I know, that sounds insane) to figure out what was going on.

It turns out what we thought were bipolar outbursts were really due to anxiety as well as dyslexia which caused immense frustration and looked like extreme anger probably because no-one was understanding him, especially teachers.

Every child is a little different, Our son has been tested and diagnosed so many times its ridiculous, but once we found a school that could handle his frustrations, things started to calm down (at home too) Its a matter of understanding these kids. Do you have an IEP for her at school?

There will be some very challenging days ahead for the whole family but hang in there, it can and does get better. I'm right there with ya!!!

 

[rodeo65]

We are another family who pulled our DS9 off all meds. He was much worse on them in terms of anxiety and rage and in the end had two psychotic episodes where he was suicidal and absolutely not himself.

I know lots of moms who say they couldn't manage without the meds for their kids, but for us they did more harm than good. DH also has extreme reactions to meds. He was once on a variety of SSRIs and reacted badly to all of them.

As CMHusband said it can take years (two of them for us so not too bad, I guess) to find the right med/combination, therapy, diet, supplements all of the above that best manages your child's symptoms. Hang in there and keep trying! We currently have DS on an amino acid supplement that DH is taking as well (we now use him as our guinea pig first), as well as managing his routine to structure in lots of activity, and keep his sugar and simple carb limited (as well as food dyes). We're not gluten free but fairly "clean". I have heard anecdotal info both for and against the supplement we use but for us it has been a good addition. Good luck!!

 

[GraceLuvsWDW]

Here are links to the outline of the diet we are on for my dd7:

http://www.fedupwithfoodadditives.info/factsheets/Factstart.htm

http://www.plantpoisonsandrottenstuff.info/content/elimination-diet.aspx

It has helped tremendously, along with, as CMHusband said, reduction of anxiety.

 

[mickey&minniealways]

I would suggest a good neurologist. He can order full neuropshych testing. From there a diagnosis can be made weather it be Autisic, Asberger, Bipolar or other. All the suggestions by previous posters are good. A good pediatric neurologist can help put all these different diagnosis into perspective and will then recomend if it is bipolar will recommend the appropriate person to see. I would go with a large teaching hospital to start with. This way every diagnosis will be checked, rechecked and rechecked again because it is used to teach students. I have 2 children with special issues and I feel that this has greatly benefited them as nothing gets missed. If one person doesn't pick something up then someone else will and then their doctors overseas it all.