Anyone with knowledge about early-onset bipolar and/or PTSD in children?

[lilgreen]

My situation is complex, involving CPS, limited court ordered consent for play therapy, a custody battle, an abusive X, a ds1 (11) who was/is abused by X and who has extremely violent rages only when he's with me, and has always been like this.

I'm preparing to go to court to get an order of consent for a full psychiatric evaluation for ds1. He had a psychosis incident last week and went after our hamster with a huge knife. (sharp objects are now all locked up). 

I am an academic, so I have been scouring academic journals trying to figure out what's up with ds1. He's certainly reacting to the abuse and to having witnessed a life time of abuse (X and I only separated in Sept 2012) and to the ongoing hostility and stress involved as we co-parent. But his rages are beyond anything within the 'normal' range of a child reacting to those things. 

He has had separate diagnoses of Anxiety NOS and Oppositional Defiant Disorder. Everyone gets hung up on the fact that he never acts up at school or at his dad's - just with me. But it seems like this is common among bipolar children. Ds1 also has extreme separation anxiety and screams or yells or cries often in this sleep. I've begun to wonder about PTSD.

Do any of you have experience with or knowledge of either? From your perspective, what do these things look like in kids? I would love to hear some btdt stories! Anything!

Thanks so much in advance. 

[PumaBearclan]

This does sound like PTSD. Recent approaches include somatic and dramatic therapies (considering PTSD to include the body/brain and mind interface) which may be especially helpful with a child. Therapies will include role playing and moving meditations.

It's possible that your son is acting out in your prescence as a sort of self-therapy because he feels safe enough with you to release his trauma.

It's likely, since your son's father is abusive, that he will use parental alienation (PAS) against you. Your son acting out in your prescence can be used against you in a claim of PAS (you are causing your son to behave this way).

I would focus on the trauma that your son has experienced, not a diagnosis for a mental disorder. I don't think that until your son is healed from the abuse, his real psychological/mental condition can be accurately assessed.

If I were in your shoes, I would educate myself as thoroughly as possible on PTSD, child abuse, PAS, and legal processes available to you. From what I've seen in the US regarding family law, integrating both parents into an agreement is considered to be the goal and in the best interest of the child. You will have to work to prove that it is not and that your ex should be kept away from the child. It is common, from what I've seen, for parents to assert their "rights" and to use the court system to continue engagement with partners and children who want the relationship to end. This is especially true of abusers, who seek attention and control.

I truly hope that your situation is resolved soon and that you and your son can put the trauma in the past.

Puma

Edited by PumaBearclan - 3/14/13 at 9:06am

[lilgreen]

Thanks so much Puma - I forgot to respond when I first read your response. 

I raised the issue of trauma with the family counsellor I am working with through our Ministry for children and families and he is looking around for a good art therapy program for ds1. 

Also, though, I am still pushing for a full psychiatric evaluation. If there is a mental illness, it would be so helpful to address that in conjunction to the therapy. I will likely have to go to chambers for this but I'm sure it will be successful since our family doctor is writing a letter, as is my father (MD with psych training/experience). They can't turn down the insistance of two medical professionals. I am in Canada.

Thank you so much for your insights. 

[Tricks4Kids]

http://www.amazon.com/The-Dark-Side-Innocence-Growing/dp/1439176213/ref=cm_cr_pr_product_top

This is a great memoir, The Dark Side of Innocence: Growing up Bipolar by Terri Cheney.

[MommyKelly]

I am answering this from a fost / adopt Momma point of view. I have a dd that was dx with early onset bi polar. We now know that she has reactive attachment disorder and conduct disorder. She ONLY acts up with me ever.  We got her at 2, she is almost 9. 

I have an 11 year old with dx PTSD . She is more of a high anxiety, almost comes off severe adhd a lot of times. She has never been violent although was exposed to a lot of domestic violence until 5.  Do you think perhaps he is having night terrors?

I grew up in a similar situation and acted out. I am more then happy to share more and answer any questions if you like :)

[deminc]

Lilgreen,

This may be totally irrelevant but I thought I will just throw it out for your consideration. is your son very bright? If so u may want to consider reading up on Dabrowski's overexcitabilities which may add another layer to everything that is going on with your child.
http://www.davidsongifted.org/db/Articles_id_10438.aspx

It may be something apart from a mood/personality disorder, or there may be more layers to it. His early years certainly sound very challenging. My son had some similar signs in his preschool years - nightmares, explosive rage, self harm and sudden change in temperament and personality - which we eventually traced to bullying in school and undetected vision difficulties as well as SPD. Nowhere near what your child would have gone through, I cannot imagine how much bigger his reaction would be in your son's shoes. I was actually afraid of him at one point - it was not childish anger but a cold burning adult hate - and his strength was startling when he was in one of his rages.

I did ask the psychologist if he was bipolar then, but the psychologist said she did not want to label at that young age, and prefer to treat the symptons and had him evaluated by a skilled OT for sensory processing disorder which can result in overly defensive actions. She did diagnose him with severe separation anxiety and also did an IQ evaluation to help determine a better school fit, as his emotional state clearly followed his school days. She also told me that he was trying to read my mind and getting it all wrong, hence part of his anxiety. I sat him down for a heart to heart talk, and as we found out more about his distorted vision, I realised that he could not read facial cues well and was misinterpreting my tone constantly. I had to clear the air with him and told him to ask directly, don't guess.

So in my son's case, it turned out to be a lot of social anxiety due to bullying, SPD and vision issues, as well as emotional frustrations stemming from his learning difficulties and mental age disparity with his peers. He was angry with himself and others a lot and worried about things like war that he heard on the radio. After we were able to locate the sources of his anxieties and frustrations, we were able to start addressing them in a variety of ways. I also realised that he was both awed by and afraid of his own anger - it gave him an inordinate amount of physical strength and he is torn between throttling the other person or bashing himself. I had to help him integrate that into his identity through stories, metaphors, and anger management skills.

It is still a work in progress, but we are definitely in a much much better place now. He does display the overexcitabilities still, but they are well within manageable levels and he is getting better at handling himself with age.

I have another cousin who has been diagnosed with bipolar disorder and is on medication. He is bright but did not complete his education and could not hold down a job despite having skills. He also beats up all his girlfriends and once, his own sister. We grew up together and i remember him to be a bright young boy with severe separation anxiety, and a tendency for sleepwalking. His father was a drifter who had beaten up his mother before and he too was beaten. I believe he could have been spared that diagnosis or at least have a better outcome, if a knowledgeable adult had been able to step in during his very unstable childhood and help him work through things at an earlier age and provide him with some coping tools.

[EarthRootsStarSoul]

Originally Posted by lilgreen 

My situation is complex, involving CPS, limited court ordered consent for play therapy, a custody battle, an abusive X, a ds1 (11) who was/is abused by X and who has extremely violent rages only when he's with me, and has always been like this.

I would guess that your DS is acting up with you because he is imitating his father.  DS saw his father abusing his mother, so he thinks that is how you are supposed to be treated.  You really need to put your foot down against his behavior.  You cannot let him continue to do this, no matter how traumatized he is.  Only allow healthy ways of dealing with his trauma--professional therapy, going running, etc. 

[PamelaMassey]

I have a daughter with mental illnesses & I did alot of research on different mental illnesses when I was in college studying for my MA degree. I am not a doctor, but as a person that was diagnosed with ptsd, this does not sound like ptsd. Your son more fits the description of possibly bipolar disorder or disruptive behavior disorder or impulse control disorder; possibly a combination of more than 1. You are doing the right thing in pushing for a mental evaluation bc the sooner he is diagnosed will make it possible for a more successful treatment. Also, is common, after all he's witnessed, for boys to continue the abuse pattern of their fathers. Don't give up hope! You & your son can stop this pattern of abuse & he can grow up & form healthy relationships as an adult.

[wild violet]

I agree with your psych- there is no need for a label your child right now. Although childhood bi-polar is considered to be more severe than adult onset I don't believe there to be any benefit in the early identification and treatment as such. This is a twofold assement, for one your child will not "recover" from this illness so early detection is not necessity; and two, you really do need to asses any trama and abuse response before you are able to see the true mental function of the child. A good many symptoms of ptsd can in fact mimic other mental disorders. Psychotic episodes are common amounst the tramatized. The brain is conditioned to a certain stressor and designed to protect itself, should a situation arise that your child has no ability to properly process the brain responds in one of two manners- acting out to seek to fulfill a need the 'only way known' (victemized behavior). The other common response is to "go crazy" (by which I refer to actions which make no sense I.e. responding to love with anger, being unable to accept the reality of a situation for what it is, etc) when the child's brain denies itself the opportunity to properly process and respond the result is often unpredictable and "crazy" behaviors. Also, I realize those two sound to be similar but I assure you they ARE two completely different responses! The victem understands the situation rationally, whereas the person who reasons with pychosis is unable to rationalize their situation, and goes into a state of mental turmoil hence the lashing out and irrational responses.

If you suspect bipolar in you child I would encourage you to keep a log, or daily diary of their mood. Mood is the indicator you need to be aware of with bipolar disorder. If you can track the day to day mood and happenings of your child's life you would be able to present your pych with a much clearer picture of your child's mental health. If you are able to identify the triggers your child has this will also help you to avoid meltdowns. Watch for changes in appetite, the amount of sleep your child is getting and familiarize yourself with the symptoms of mania and depression. Bipolar is a disorder which displays cyclic patterns of shifting moods, between baseline (so called normal behavior expected of a typical child), depression (characterized by sadness, disinterest, lack of energy), and mania (state of high energy, grandoise thoughts, decreased need of sleep/food). There is a difference in type I and type II also, the type two child will display both symptoms either in rapid cycle, or in the form of mixed episodes (depression and mania co-concurring). This makes for type II slighly harder for parents to identify since you may see mixed signs I.e. needing less sleep while also having no interest in things which normally bring the child joy. If you truely suspect bipolar track the mood, energy level, and symptoms of the child long term along with the enviromental factors which may have brought them on. This will be the most useful tool for you AND the professional helping your family, much, much more insightful than any assesment could ever be! Empower yourself by continuing to educate yourself as to the possible causes of these behaviors and ways to help your child. Best of luck to you mama! I applaud your efforts to seek to identify, understand, and help with the troubles facing your child. You may not see it now, but I absolutely assure you of this- he will be greatly benefitted by the very fact you are concerned enough to take action and seek help now. No matter what dx you are given for him, remeber he is first and foremost a victem and respond as such.

Also, if I may make a suggestion? I would encourage you to shift some power to him. Likely he feels powerless over the things happening in his life, and a boost in esteem would do worlds of good for him. As I said, treat him as the victem, and go gently but encourage growth emotionally . Abuse can greatly hinder development, whereas a little faith can go a long way towards recovery. Show him you believe in him. Give him opportunity to control aspects of his life (no matter how inconsequential they may be, the impact will astound you!
Edited by wild violet - 5/19/13 at 3:59pm