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My 4-year-old ds is a handful. He has all the symptoms of ADHD, and he's on Metadate right now. But there are other symptoms that I am just not sure about. His birthmother has Bipolar and was treated for ADHD as a child.
He is doing okay on Metadate. Much calmer, more focused a little less impulsive. But he's very intense, very sensitive. He's never really been aggressive or mean. But he loves to push buttons, mentally. Always has, even at 1 year old. He gets so much joy out of annoying everyone. He used to run around with a stick, chasing the other kids, but he didn't usually hit them. He would hit/push to a normal degree. The only thing I can say for sure about him is that he's VERY reactive. If he is hit, pushed, bumped into, etc. he will react and hit or bite, etc. He gets into a totally different mode when he's threatened or yelled at. He can't back down.
He's also had a fascination with knives or anything pointy to use like a knife/sword. He, at 15 months old, and having never even seen a show with a sword, would run around with the toy knives, pretending to stab people. Since then, they've been put away. I just recently took them out again. The biggest problem before was that he would gently hit everyone with them.
My fear right now is a new expression he gets on his face, along with raging anger. About 6 months ago, he started with a new anger side of himself and defiant to an extreme. He can rage for hours, then he'll be fine for a week or so, then rage 4 times in one day. Or just once. And I have to hold him down, because it's always related to something he can't do or have and he will run to go get it, tear everything apart to get it, etc. I can't just ignore him.
On to my true fear. A few times, recently, he has picked up a toy knife and held it like he's going to stab me, with an evil look on his face. He looks like a kid from those horror movies. His face is down and MAD and his eyes are rolled up in his head. His behavior is not normal, and I'm not sure it can be attributed to ADHD alone. But I can't get anyone to help me figure this out, especially because of his age.
Does it sound like he may have Bipolar as opposed to ADHD? Or ODD along with ADHD? Or something else entirely? He has been diagnosed with ADHD by neuropsych, so he's been through an evaluation. And he's on the FASD spectrum. The only issues are behavioral.
Honestly, it sounds more like attachment concerns, RAD, than anything else. I'd start there.
ETA: Juvenile Onset Bipolar doesn't look like this. It involves RAPID cycling through the manic/depressive stages. Usually several times per day. That's just not what you described. RAD, imho, fits the bill better.
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He sounds a little like my son...hyperactive, impulsive and intermittently explosive. Kiddo will rage HARD for a couple of days and then have a few good weeks. We're also trying to tease out if his behavior is related attachment, ADHD, bipolar, alcohol exposure or something else. One thing I did think about when reading your post was sensory issues...they can look like ADHD (and be caused by/related to exposure). I think exposure is the most likely cause for my Kiddo's behavior, but we're getting ready to have a more complete evaluation.
How long has he been on the metadate? We experienced serious anger and raging side effects after my son had been on it for a while. Just a thought!
I agree that it can be hard to tease out exactly what the cause is because so many behaviors overlap different diagnoses. Along with rapid cycling, my understanding with bipolar is also that the mood changes are not generally related to any outside trigger - whereas it sounds like with your son, there is a trigger but his reaction is really out of proportion. My son does this as well - although perhaps not quite to the same extreme. But his diagnosis is emotional dysregulation rather than bipolar or ODD. As Adoptsis mentioned, sensory issues play a part, too. We've been told that this is not an uncommon diagnosis with meth exposed kids. In our case, one thing I'm sure is NOT causing his issues attachment - although some of the behaviors are certainly the same.
My son, like yours, has a maternal history of mental health issues. We've been told that his vulnerability is not just to having the exact same mental health diagnosis that his birth mom has. He is more vulnerable to mood disorders, anxiety disorders, etc. We were told that intervention now would be important for him. I would definitely be looking for a more complete evaluation for your son since it doesn't seem like ADHD necessarily covers all of his issues. Unless, as Dpline suggested, this is a drug reaction. Did the escalation in his rages happen after he started the ADHD medication?
He has been on Metadate for about 6 weeks. We recently increased his dosage. He was on Adderall and Focalin before this, and he was a raging mess on those, but also did not eat. It was a nightmare. That, plus he wasn't any better. On Metadate, he is playing with his toys for the first time ever. It's amazing to watch. But, he's also less happy/animated and more emotional. I would like to just blame the medication, but he continued to rage when off of the meds :(. I am not sure if I took him off for a few months, if he would go back to "normal". He did have a few tantrums before meds, but just not the degree. Before the meds/stopping nap, his tantrums would happen when he skipped nap and didn't eat. He's being evaluated for hypoglycemia.
We were in the delivery room for both of children's births, so they have been with us since the beginning (both have the same birthmother). I don't see RAD at all. Sometimes it's hard to convey exactly what's happening when writing :).
I did explore the sensory route. My dd is much more sensory oriented, and we're waiting on OT services for her. I took him to an OT for 8 weeks and there was no point. He had fun playing, but nothing helped. The more he moved, the more hyper he got. I just don't see the sensory part in him. I also tend to think that it's all ADHD, some with Sensory Processing concerns added to it.
The escalation did start after he started meds in general. BUT, a lot has happened in that time. He started preschool 2 mornings a week, stopped taking naps (he just has quiet time for 2 hours in his room, but will not sleep), my dh moved 1,000 miles away in August (and has only been back to visit over Christmas) for work, we plan on moving to join my dh in June and he knows it (and wants to go now). Also, he's older and my expectations are growing for him, as they should.
And I was thinking Bipolar because he does cycle rapidly. He will rage and then be giggling an hour later. So, I just don't know. I've said from day 1 that he's either REALLY happy or REALLY not. There's little in between.
We are on the waiting list for behvaioral health to hopefully help out. We are being sent to the main hospital, where they have access to a nutritionist and a psychiatrist as well.
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