Possible bi-polar and/or ADHD in a 5 year old--help me help my nephew, please.

[JudoMom]

I talked with my Mom and she wants me to call my brother. They have taken their 5 (6 in May) year old son to some specialists to find out what is wrong with him. My mom said they are tossing around bi-polar and/or (not sure which) adhd as dx for him. There is also a younger brother who will be 4 in March who is as out of control as this brother (the parents refer to him as the mean one :().

Some background-his mom & maternal grandfather are thought to be bi-polar (this is 2nd hand knowledge from my mom, and my SIL's family kind of has a worst-case scenario/must be medical/hypochondria thing going on, so my family tends toward hearing what they say about medical issues and taking it down a notch or 10). My brother & his wife are also very inconsistent parents, from what I've seen (I live several states away) and from what my mom has told me (she lives 5 minutes from them). My brother is also fairly uninvolved and a workaholic. An example of a recent discipline method my mom witnessed was my SIL had dn5 sitting at the coffee table writing "I will obey", only he can barely write his name and he cannot read, so he was crying and saying he couldn't do it, which was probably very true. SIL thought this punishment made perfect sense. Both boys spend a lot of time with their maternal grandmother, who has said flat out that she won't discipline them because she is the Grandma. The boys do obey my parents, for the most part, because my parents have rules and enforce them. They used to obey at preschool, but I guess that's gotten out of control and this is why they've taken the older boy in for testing.

If it is medical, I want them to find it and help him. In addition, I do think that bipolar and/or ADHD are very real for some children. I must admit, though, from my outsiders perspective it really appears to be inconsistent parenting, and I'm worried that they are going to end up medicating this boy in the hopes of controlling him, rather than just parenting him.

From those of you who have experienced testing, etc. for these things, what are important questions that I should make sure my brother asks the doctors? Like I said, if any part of his behavior is medical, I do want to make sure it is detected. If I'm going to call him, I'd like to be informed when I do it.

I'm sorry this is so rambley, but I would really appreciate any advice you can offer. I wanted to give my whole perspective on the issue and I'm hoping I don't sound too terribly judgmental and I really hope I don't offend anyone (I know many of you have suffered the judgment of others, and that's not my intent at all). I just really want to help my nephew.

[Claire]

You might get additional responses by posting this on the Special Needs Board. Several people over there can recommend good websites and books for information.

My limited understanding is that bi-polar can be very tricky to diagnose in young children. Also, that ADHD meds can have very bad side effects if the child is actually bi-polar.

My advice would be to make sure the mother is evaluated by a psychiatrist as well as the children. If she's bi-polar she will need treatment if there is to be any hope of consistent parenting.

[Whisperlily]

Both of these things can be difficult to diagnose in a 5 year old. If they're truly seeing a psychiatrist, they will do a thorough screening, including questions about home life, etc.

I know there are some bad experiences out there that lead people to believe that if you want a diagnosis, you just go get one. That's really the exception rather than the rule. If they feel they need to seek help for their son, at least they're trying to help him. Hopefully if they decide he needs medical intervention, they'll also receive education, support and counseling. If it turns out that he's normal, and there are parenting issues, it might be a wake-up call for the parents.

[Ria]

I watched something similar with the neighbor family. The parenting was horrendous...mom is a psychotic witch, IMO. The youngest had multiple behavioral issues. Mom couldn't accept that she might be to blame, so she took the kid from doctor to doctor and had him drugged beyond belief. Fast forward 13 years...he's now 18, mom is still psychotic and has just kicked him out of the house. He's been under the wing of social services for years, and they know the problem is not him, but her. Unfortunately, he bears the scars of the way he has been treated.

I'll pray for your nephews. It sounds like the entire family needs help. I guess there's no way you could assume custody, eh? I feel for those boys. Watching what has gone on next door has been tough.

Ria

[OnTheBrink]

My ex is bipolar and I am going to tell you what his two psychiatrists have said to him. Bear in mind, one of these doctors is a Yale grad, the other from Harvard. Ok, you may not like this but both doctors have said there are studies that are now showing that bipolar is learned, not genetic, not chemical. Meaning, it's behavior that's modeled to the child and the child repeats it, grows up thinking it's normal behavior and parents spend a lot of time trying to "fix" the child.

These doctors believed this to be the case in ex's situation, because ex *can* control his emotions if he has the motivation to, as can his mother, brothers and grandfather, all of whom exhibit the same bipolar symptoms.

I'm saying this, because I'd HATE for any child to be put through the rigamarole of meds for years to find that he really isn't bipolar (mentally ill) at all; he's either had ineffective parenting, or he's suffering from allergies (dairy allergies can cause mood swings that imitate bipolar disorder) or some other situation that appears to be b/p.

I'm not assuming your brother and his wife are bad parents; my first reaction to your post was that it could be an issue of allergies. I'd encourage your brother and sil to explore all possible reasons behind these children's behaviors and to not let a doc immediately label them bp or adhd immediately and hand them a scrip for meds.

[Whisperlily]

(dairy allergies can cause mood swings that imitate bipolar disorder)

Have you ever seen any studies on this? I ask because I have this exact reaction to dairy. My daughter does as well, and although there's an absolute 100% undeniable reaction to dairy, most doctors dismiss it. We've learned to simply manage our intake of dairy (little to none) and go about our life, but it would be nice to see "how and why" it happens to us.

We've also noticed little things about it, such as... the higher the cream content, the worse the reaction. We don't know what it IS in the cream that causes the reaction. I've been curious all my life. ;)

[Mandamom]

had her now 9 year old diagnosed with bi-polar a few years ago. He is currently on meds and doing VERY well. He had some earlier diagnosis as ADHD but it was later changed to bi-polar. He has always been EXTREMELy challenging and there is good parenting going on in that household. Anyway, I'll see what I can find out for you.

I have to edit this because I JUST had another friend e-mail me whose daughter was just diagnosed after an EXTENSIVE evaluation. I'll see what I can find out. They are still in early stages of getting info.

[Lolly]

I have known two young children dxed with bipolar. One is the child of a close friend. She had severe problems from birth on with behavior. Parenting was excellent, but this child was one extremely wild girl. She was dxed as bipolar at the age of 4 or 5 and put on medication. Her behavior improved in the sense that she became more controllable. Sedated is probably the best description. At around the age of 9 or 10, her parents consulted a different doctor because of the amounts of medication their dd was taking. This doctor took her off of all of her medications. This 60 lb 10 yr was taking enough medication in one day that would have knocked her 6'5", 200 lb father out (literally) for a week. Turns out, after much extensive testing, that she was not bipolar but suffered from a congenital brain deformity that was causing her problems. She is now 13, in a special ed class, and off of all medication. She obviously still has problems, but they are being addressed in a manner that doesn't involve dangerous, brain altering drugs.

The other child is my dd. She also had excellent parenting (I hope). :) Her behavior was excellent according to everyone outside our family. Her rages were almost all contained to private moments. (Of course, there was the time she threw a chair at the preschool director.....) We ended up at a specialist office. A true leader in his field. Excellent references. He dxed her as bipolar and put her on those lovely pills. My dd becdame someone I didn't know. She totally lost all of her personality. She could literally no longer walk across the backyard without falling over her feet. She couldn't catch a ball. This was a 6 yo who could do backhandsprings on her own. Almost do a standing tuck. She did quit tearing my house apart when she came home from school. The doctor said we just needed to tweak her medication with another one. Give her time to "get used to taking the meds". My inner voice was screaming that this was wrong. We took her off of the medication and never went back to that doctor. My own research had shown that frequent feeding sometimes helped bipolar kids. I started feeding her every 2 to 3 hours. She quit having rages. She still didn't sleep, but she quit hurting her siblings and tearing up my house. The nurse at the psych office had mentioned homeschooling to me. I withdrew her from school and brought her home. That way, she could sleep on her body's schedule (better than in school anyway) and eat at regular intervals. (I had been checking her out of school everyday to feed her during the day.) Today she is 15. She still doesn't sleep well at night. Bedtime before 1 just doesn't make sense to her body. She no longer needs to eat as frequently as when she was little. She does recognize her body signals that her sugar is falling and she needs to get food NOW. She is extremely artistic and bright academically. She doesn't usually work to her potential because she doesn't like to feel disappointed. (If you don't try, it doesn't hurt when you don't do well. Only a perfectionist can understand.) She does well enough without trying too hard. Overall, she is doing excellent in life and is on zero medication.

My observation on bipolar is that it is over diagnosed. Does that mean it doesn't exist? I'm not going to venture an opinion. It is way too easy to get a diagnosis. If the mother is going in thinking that is the problem, she will most likely get the diagnosis, especially if she is seeing a doctor who is known as a specialist in this field. That is based on my experience in office and from frequently boards pertaining to bipolar children. If there is a problem with parenting, that would certainly need to be addressed before medicating the child.

What can you do? Nothing. If parenting is the root of the problem, you aren't going to be in a position to do anything. You can let them know that you know a child who the problem was most likely low blood sugar who was mistakenly dxed as bipolar. This seems to be a problem with many children who are dxed as bipolar. But, if the problem is parenting, feeding them won't help.

Sorry I'm not really any help. My experiences with this issue have been very negative.

[Ottakee]

I will give you a flip side story here. A positive one, I hope.

My 12dd has bipolar, diagnosed at 5 but symptomatic since she came to us at 7 1/2 months old. We started seeing a pediatric psychiatrist before she was 3.

She is now on 3 medications, 2 of which are also seizure meds as she has seizures as well. She is doing SOOOOOOO well. She still has special needs due to a mental impairment but the differences in her are amazing.

At 5 she was homicidal and suicidal--hallucinating about knives and buckets of blood, etc. Once started on the right meds, we have never seen that again. She is not aggressive, irritable like she was, etc. No more hiding under beds and tables so depressed she wouldn't even go outside to play.

I do think that bipolar is VERY real and does occur in children. There are, however, many other things that need to looked at and ruled out first--things that can go along with bipolar or look like them but need vastly different treatment.

1. food allergies---we did the dairy free, gluten free, etc.--didn't work here but makes a huge difference for sensitive kids.
2. EEG for seizures--turns out dd has seizures as well--which makes some meds non options for her, but other meds good choices.
3. Thyroid---hypothyroid can cause behavioral/depression symptoms and needs a vastly different treatment.


I think the mother needs to see a psychiatrist as well and get on appropriate medication, if needed. A stable homelife will not cure bipolar but will make everything much easier and make it easier to see if this is more behavioral or chemical.

I would have them seek out a TOP NOTCH pediatric pscyhiatrist. Go to www.bpkids.org and look for the "find a doctor" link. You want someone with lots of experience to know what they are looking at and what else needs to be ruled out.

A full physical would also be in order with blood work for anemia, lead level, thyroid, kidney/liver function, blood sugars, etc. If anything pops up here, that should be addressed first, if not, then you have a good baseline before starting meds.

I hope this helps. Bipolar is highly genetic......meaning most people with bipolar have a family member with it as well.

[Mandamom]

First, read The Bipolar Child as a starting point. A lot of doctors aren't very good at diagnosing this in children. If there is a family history of bi-polar it, bipolar needs to be carefully eliminated as a possibility.

The evaluation my one friend just went (family history of bipolar) through consisted of

* blood tests to make sure there wasn't anything obviously physical going on
* a couple hours of interviews with parents and grandparents who are close to the child.
* Interview of teacher
* additional written assessments to be filled out by above people -- not just one or two.
* additional interviews of additional teachers
* another 6+ hours of talking to child plus additional assessments and evaluation filled out by dr.
* final wrap up session to explain findings.


My friend said that it was very clear at the final wrap up that they understood her daughter and weren't just saying something to start trying drugs right away.

Good luck.

[JudoMom]

I will check out the resources you guys have mentioned.

[Ottakee]

Just wanted to mention also that often bipolar is a "working diagnosis" and that the doctor might use "mood disorder NOS" at first until they figure out for sure what is going on.

We knew that my dd had some severe issues from infancy on but the psychiatrist didn't formally diagnos it until she was 5 and the dr. had been working with her for 2 years.

They also often require weekly or biweekly counseling for the family as part of the treatment plan. That would help with the parenting, etc. as well if that is an issue.

www.bipolarchild.com is another website to check.

[8FillTheHeart]

My ex is bipolar and I am going to tell you what his two psychiatrists have said to him. Bear in mind, one of these doctors is a Yale grad, the other from Harvard. Ok, you may not like this but both doctors have said there are studies that are now showing that bipolar is learned, not genetic, not chemical. Meaning, it's behavior that's modeled to the child and the child repeats it, grows up thinking it's normal behavior and parents spend a lot of time trying to "fix" the child.

These doctors believed this to be the case in ex's situation, because ex *can* control his emotions if he has the motivation to, as can his mother, brothers and grandfather, all of whom exhibit the same bipolar symptoms.

I'm saying this, because I'd HATE for any child to be put through the rigamarole of meds for years to find that he really isn't bipolar (mentally ill) at all; he's either had ineffective parenting, or he's suffering from allergies (dairy allergies can cause mood swings that imitate bipolar disorder) or some other situation that appears to be b/p.

I'm not assuming your brother and his wife are bad parents; my first reaction to your post was that it could be an issue of allergies. I'd encourage your brother and sil to explore all possible reasons behind these children's behaviors and to not let a doc immediately label them bp or adhd immediately and hand them a scrip for meds.


Gee......I guess I really screwed up with just one child somehow but really did great with the other 6. Six happy, normal healthy children and one that kicks holes in walls and doors, throws things, and become extremely violent and scares his siblings. Nope.....none of that being modelled in front of him.

Sorry, this post made me really angry and it takes a lot to do that.

BTW.....we have done elimination diets and allergy testing......sometimes medical problems are simply medical problems.

[sdWTMer]

I do agree momof7 that sometimes it's just that: medical problems.

[8FillTheHeart]

My brother & his wife are also very inconsistent parents, from what I've seen

Quite honestly, parenting a child with this type of behavior is beyond exhausting. I have closed myself in my bedroom and curled up on the floor in tears many times. What you may see as inconsistent parenting may simply be the result of having even more extreme out of control behavior b/c having visitors has escalated the child's behavior and the parents are simply in pure coping mode.

I don't know the family, so I don't have a clue. However, I have had family members make comments to me like...."leave N here with me for a few weeks and I'll fix him." My child suffers from a medical condition. I wish I could leave him with someone for a few weeks and have them "fix" him!! Unfortunately, it is a real medical condition.

It sounds to me like the parents are not ineffective. It sounds to me like they are seeking answers to questions that they live through daily. I would stay out of it and let the parents do what they are doing.

FWIW......I am no longer on speaking terms with one of my sisters exactly b/c of this situation. Quite honestly, it is hard enough to deal with on a daily basis without outsiders trying to tell me what I should be doing.