[usehername]

My daughter is suspected to be bipolar. She is enrolled in online public school due to her asthma and behavior problems. She is currently on ADHD meds that are clearly not working for her. She has a pdoc appointment next week (they will not see her sooner, I've been begging for months).

She is 11 and in 5th grade (supposed to be 6th). She is currently in a very down place... I can't even get her to shower. I'm having a hard time telling what is her being a spoiled brat and what is her being mentally ill. Needless to say, she has refused to do any schoolwork for the last week. I take things away, I try to bribe her, etc, I'm met with nothing but god awful tantrums, like a two year old would have. Flailing on the ground, screaming, hitting, throwing things, etc. These tantrums happen regardless of what mood she's in, they are just different with both moods...

Thankfully, the neighbors all know she has problems - it shows - or CPS would've been called by now. She almost never sleeps, despite being on 100-150mgs of trazadone each night.

I'm at my wits end with her. What the hell do I do?? Does anybody have any idea how to motivate someone to do schoolwork while they are in the depths of despair? Or some terrible manic hell? I can't even tell where she's at most days. I asked her and she said she's been sad all day, and angry that she can't sleep. Her pdoc only barely believes me that she's even having mood swings, chalking it up to age. She's been like this FOREVER.

[A Red Panda]

What sort of a structure/schedule/routine does she have for the day? I find with my students, that having a predictable and "safe" routine is the best way to go. Things can be changed around, but that routine and consistency are key. (I'm NOT saying that you don't have a routine nor am I saying that you're not consistent - I don't know anything about how your days are run is all).

Can you sit down with her at some point when she's alright, and work out a new schedule? Schedule in what time she's to be eating meals at, what time she is to take a shower, etc. Work in all of the daily routines. Also work in school lessons and activities in to the schedule, and spread it out and mix it in with free time.

If possible, you could make a big weekly board that has the different activites on and what time they're be done it. Put velcro on so that things can be changed around.

Say, if she's supposed to be reading from 2-2:30 and she decides to refuse to do her work? Well, then that reading square would be moved to her next "free time" slot. She needs to accept that she has responsibilities, but it can give her some control over when she does them. If she has it scheduled to be working on math from 10-10:30 and then decides that she would rather watch tv during that slot? That's fine. She can go and swap out whenever her tv slot is and do the math during that time instead.

It gives her some ownership, but also reinforces the fact that she does have things she needs to do. Point out to her that "tantrum" isn't on her schedule and that it would take up a "free time" slot so if she's hoping to spend time playing with her toys, that she'd best not waste it.

Then forgive things if it's only a few minutes.

Honestly, with my students? (They're in grade 4). With my behaviour kids, I do have a "relax" area where they can remove themselves from the activity and sit and chill/read. After they've been there for a bit, I go and sit with them and ask them what's up. Usually they'll tell me. If they don't then I leave them be for a bit. Sometimes they'll rejoin after talking to me and I invite them back. Sometimes they just return on their own. Regardless, they know that the work that they're not doing still needs to be done. I never excuse them from an assignment.

Sometimes just walking away works. Like "Julia, this isn't helping you. You still need to do that math work. I will talk to you later." and then walk out of the room and let her scream it out. When she's calmed down, then ask what made her so upset. A lot of the time it's frustrating or confusion or perfectionism over the work. Then give her a helping hand.

[Victoria'smom]

Our son hit the jackpot with ADHD, asbergers and bipolar. He's also 11.

He had tried all the adhd med cocktails and nothing worked. As he continued therapy it was quite apparent that wasn't the only issue and another full psych exam was ordered. We ripped him from a the ADHD medication it wasn't working anyway. An anti-psycotic was prescribed because of his paranoia and anxiety. After a while we were told we need to focus on his mood disorder before his adhd. So we found a good mix for his bipolar then worked on his ADHD. Now his patch only works for about 4 hours but enough for school hours.

I don't feel a third opinion would have happened without his therapists (and our therapists) notes. If she is not in therapy then get her somewhere where her therapist and psychiatrist worked closely. His psychiatrist does not put bipolar in his chart but he is on only bipolar medication and ADHD meds. She sees us monthly for med adjustments because of puberty. She tries to keep him as outpatient basis but if need be there is a kids partial hospitalization program on campus. My son is on seraqol to sleep and stabilization.

I home school my son to ease his symptoms. He sleeps as need. Doesn't get vacation, summers or weekend. It's to hard to go back. He only does 35 min a class and a 20 min. essay a day. It's time4learning so it's educational videos and games. Same schedule every day. Equaling 2 hrs 40 min. Instead of classes on Wednesday he role plays a character which helps with social skills. He use to go to a co-op every 2 weeks which was a class room setting with class changes and everything. He still does field trips when he is healthy enough. We don't have the same requirements as homeschooling that public online schools do. So if he sits there for the school time that's his issue. I don't have to stress, I'm not on a schedule and until he chooses to do the require things or get his GED it's his problem that he's adding years. On bad days we just watch documentaries, read in bed, work on therapy skills, play games, run around in the park, go to the movies, or plays. At some point he'll have a short time he can do work and if not I have all the documentation that he did something keeping logs and journals. By the end of the year he is always close to grade level. If you don't mind me asking which online school she's in? Are you talking to her teach that she's having a difficult time?

We also have him keep a kids mood chart and write to his therapist every night, I do this too. Does she by chance have an IEP?

You can PM me whenever.

_____

Oh, with the showering and things like that keep track of it and only 'really' fight when leaving the house. Some times eating, wearing somthing and resting is enough of a fight.

[IndieVisible]

Trazodone only helps people that really don't need much help to sleep. For those of us that really need a lot of help to sleep, it does nothing. Even 200mg of trazodone only gets me to yawn at best, and I stay up all nite. I have no idea why doctors keep prescribing trazodone for sleep?! For most of us that really do need the help it's because our brain is racing and we can't shut it down. Benadryl is another one that does nothing for me. Even 2mgs of Xanax only gives me 3 hours of sleep and I never feel rested. Finally got seroquel and I sleep like a baby.

Your daughter is not a spoiled brat. I really think she is under a lot of distress! Hopefully your next visit will shed some more lite on this and she gets the help she needs! Good luck! Let us know how you make out.

[usehername]

Thank you so much for your replies. All have given me many helpful things to consider.

As far as scheduling goes, we really have problems because of her totally random sleeping. Today, she woke up at 2am. She was frustrated all day because she wanted to go back to sleep but couldn't shut her brain off. I agree that she's really having problems... I hate seeing her suffer and not being able to do anything about it.

Lol benadryl makes her WIRED. I hate the idea of her gong on APs but she's already self harming and I hate to think of where that can lead as she gets older. A woman I know told me today that her kid was moody and couldn't sleep too. She killed herself at age 16. :'( sad and scary. I can't imagine what that lady must have gone through. I really feel for her.

I think I'm just having a hard time knowing which parts are my issues and which parts are mine. It took years to get her into a shrink, and she's on medicaid so her visits are few and far between and will end altogether soon. I'm afraid for her.

[usehername]

Oh and she is working closely with a therapist. He suggested meds, which is how I got her into the pdoc.

[Victoria'smom]

My son had his first suicide attempt at 8. He SI by picking at his skin. Until he went on an AP he continued to have those thoughts nightly while crying hysterically how horrible he is (when his mood stabilizer ended for the day) Melatonin helped him sleep but the AP helps control his SI and his mood after hi I think recently he mentioned something serious where his therapy increased his therapy.

________

It doesn't sound like your therapist and psychiatrist are talking to each other and they should have very open communication. I assume that your psychiatrist doesn't know she self harms. Does her therapist even know? Tell her that you'll be there with her while she tells them but that's what they're there to help with.

[usehername]

I'm not sure how much they know because she told me she's afraid to be honest with them. We tried melatonin and even combined with Valerian it didn't touch her. She was on both for years.

I will tell her pdoc that she hadn't told him the whole story because she's afraid. I think his nurse has a little too much say in her treatment and doesn't take me seriously. She's frustrating to deal with.

[IndieVisible]

I bet Seroquel (quetiapine) will get her to sleep like a baby! It works better then ambien for me.

How much is she mirroring you and your behaviour and issues? Sleep is one of the most important things in regulating mood. Get that sorted and you might see improvements in daily life. How is her diet and exercise routine? If she cant sleep is she doing enough physical exercise? For children this can be a few hours a day of vigorous exercise, outdoors is preferable. Diet can have a huge impact on childrens behaviour. I have seen it for myself over and over again in my work, try cutting out ALL artificial colours and flavourings, stick to fresh healthy food, no packet crap. It will take months for her body to regulate itself again so dont expect miracles in the first few weeks.

Therapy is always a good thing. I wish I had done CBT as a younger teen, that really could have changed my life.

Goodluck, it is so so sad to see so many people on this forum with mentally ill children.

[usehername]

Originally Posted by IndieVisible

I bet Seroquel (quetiapine) will get her to sleep like a baby! It works better then ambien for me.

Like the baby she never slept like, I'm sure. She has literally always had problems with sleep, even as an infant. I followed *perfect* sleep hygiene and a *perfect* freaking bedtime routine with her for YEARS and finally gave the hell up when she was about 9 or 10 because all she ever did was toss and turn for hours, telling me her brain WOULD NOT STOP. This was about the time I had to pull her out of regular school. She *used* to get regular, strenuous physical activity, but now it's only on upswings because her down swings go so low. Today I had to fight with her just to get out of bed, and she cried (real tears) all day long. I feel so bad for her.

Her pdoc told me once all of the ADHD meds were shown not to work a lamictal/seroquel combo would likely be the next step for her because staying awake for three days straight pretty clearly is a bipolar symptom. I remember her being two and being able to stay awake for days on end. She never even seems tired unless she's depressed, and even then, she still doesn't really sleep well or much. I know *we all* know what that feels like, but I seriously doubt there are other MI that can cause highs & lows like that.

Whatever is going on with her needs to be nipped in the bud before she fully hits puberty IMO. My entire family (all women because we all drive men away) is bipolar, and we all freaked out and went nuts as teenagers, all of us had multiple suicide attempts & frighteningly risky behavior from about ages 12-25.
I'm glad that her self-harm attempts are so far limited to smacking herself on the head repeatedly and or slamming her head into walls and or failing on the ground, but horrified that she is even doing that at age 11. She has NOT mellowed with age, and I fear she won't until she's around 30. I know I *still* haven't mellowed at 31.

I'm sure there are *plenty* of other factors at play here, but sleeping is my top priority for her at this stage of the game, because I'm sure it would help to regulate her moods some all by itself (then again, pdoc said that about me. Not that seroquel puts ME to sleep). Her dad isn't around a lot, and is somewhat scary when he is, and refuses to give her any meds, including those for asthma. She's not on many, and no steroids unless it's life or death - she has a history of psychosis on anything that speeds her up at all. She has a history of mild psychosis OFF of everything.

I blamed myself entirely for her behavior until our family doc looked at me one day and said, "you know, (pointing at her) NONE of this is normal" as she bounced all over the room talking a million miles an hour. Every other doc she sees agrees there, except her pdoc, who she hides things from because she's "too scared to talk" - probably because she knows her father has access to her records. My mother thinks her behavior isn't that far out of whack, but she's nuts, and also thought *I* was "normal". I am very clearly not normal in anyone's eyes. She is a good kid, I'll give my mother that, but I've made a point of sheltering her to make sure of it. But I can't shelter her forever. So she's gonna need some help dealing.

I don't know. I feel up in the air about things. So far we know that adderall makes her see and hear things, and bounce off the damn walls so fast the kitten can't keep up with her, intuniv makes her depressed (or?? maybe it's just a cycle?), and trazodone helps her IBS and blood pressure but nothing else. She also said some very scary things about death and nightmares she was having while she was on the adderall. It made her so much worse that my little sister stole the bottle during a visit with her. Wrong approach, but right idea. It didn't help her any.

I would love to fix her diet, but have no clue how since she's so out of control. There are days when she won't eat at all - like most of today, so I give in when she asks.

?????

I'll keep you guys posted on her progress. I feel bad for giving her my terrible genes (and her father's terrible genes).

[usehername]

LOL any idea what phase *I'm* in right now?

[Victoria'smom]

The "mommies going to pull her hair out unless everyone is quiet" stage

[usehername]

lol Nope. She's on a downswing so she's quiet. I miss her noise.
You can tell I'm manic when my posts get that long, generally.

[IndieVisible]

Don't worry mom, she will be fine! She has a good caring mother to watch out after her. Once they find the right med combo things will settle down. Please keep us posted on this!

[Victoria'smom]

Today I had to fight with her just to get out of bed, and she cried (real tears) all day long. I feel so bad for her. Next time if you have the time cuddle with her and read aloud for the day.

lamictal/seroquel combo That's my son's combo but he has the daytrana patch also. They have dissolvable lamictal (orange flavor) but the pdoc has to write the script saying dissolvable. (medicaid will pay for it.) The low dose patch was added after because he does have adhd and the continuous release over 9 hrs help when nothing else worked while keeping his mood in check.

I was told prepare for teen age years to be one big mixed state.

she's "too scared to talk" When my son told me that I hugged him and told him "I get scared with my pdoc. So I write. All my scary stuff goes in this book (a little magnetic purse size note book.) I give it to him and then I don't have to say the scary stuff. The best part is he gives me that book back. So he gives me back all my secrets. So it's like he never read it." Then we got him a book.

Is her pdoc a pediatric pdoc?

Try not to blame yourself. I know it's hard but your doing everything you can mental health wise. She has much more of a chance learning the skills she'll need to help her. She'll probably have better coping skills then most.

[usehername]

I took my daughter to her shrink appt yesterday. The pdoc wanted her on seroquel but my family is so against that particular med because we've all been on it that I declined, at least for now. He's decided to lower the intuniv and see what happens. He probably will take her off of it entirely. In a week she stars risperidone for racing thoughts, self harm, etc. If he decides to d/c the intuniv (likely) he will start her on either an AD to see what happens or a mood stabilizer. We hope he sleep improves with mood improvement, but I will continue to educate my family. I reminded them that risperdal is only slightly below seroquel in terms of weight gain (primary concern for her) and side effects. We'll see what happens I guess.

[Victoria'smom]

I don't pretend to know about seroquel but son's Pdoc says weight gain doesn't start until 200mg. I tend to believe her. My pdoc has that as my PRN /not PRN and knows I will not approve of weight gain.