A few years back I wrote about how my son (who was 12 at the time) took Abilify as a stand alone medication for a few months and had suicidal thoughts while he was taking it.   This was unusual for him as he is not a suicidal kid in general and when we discontinued the medication due to it giving him tics of odd tongue movements and neck rolls, the suicidal thoughts discontinued-as did the tics.

Over the years since then I have received quite a few emails from people relating to that post and sharing similar issues of suicidal thoughts or tendencies while taking Abilify – either with themselves, their loved ones, or their children.  Because I have no way to verify the legitimacy of these emails, I have not written about them.  However, a few days ago I received an email from a man saying that his fiance completed a suicide attempt and he is now devastated by the loss.  I was struck by that email.   He attributes the suicide to her taking a combination of Pristiq, Abilify and Adderall.

He says:

The pills made her more and more irate, unapproachable, wild, irrational, paranoid, and completely not “herself”…Definitely not the person I met and fell head over heels for. She nose dived in a matter of 2 to 3 months with the biggest hit coming with the addition of the Abilify.

_______

I cannot get this email out of my mind.  As you know, stimulants caused huge issues for my son and Abilify was not good for him either.

If your child or family member is taking stimulants (Ritalin, Adderall, Focalin, Concerta, etc.) and/ or SSRIs or SNRIs (antidepressants like Prozac, Zoloft, Effexor, Paxil, Pristiq) and/or Abilify and they are suicidal and/ or worse than they were before they started the medication and/or simply cannot get stable, PLEASE consider that the medications that are supposed to be helping them could be making them worse.   Do not discount their behavior as simply a part of bipolar behavior or as you having a child that simply cannot get stable.   Stimulant medication and medication with stimulant-like properties does help people that can tolerate it but it can also wreak havoc on people that can’t and even more so on bipolar teens, children, and adults.

This has happened to us, it has happened to others, and it can happen to you.

We met with the new psychiatrist this week.  Or what may become the new psychiatrist.  I say ‘may’ because I have also made an appointment with another psychiatrist so we’ll see who we like better.

So, how was he?  Well, ok, I guess.  This one is fairly young.  He’s less than 10 years out of med school and he’s young, energetic and tried really hard to be ‘hip’ and connect with Rye.  And Rye seemed to like that.  As for me, though, I was a little more leery.  I tend to like older, more tried and true doctors who have seen it all.  Rye’s previous psychiatrist had well over 35 years of experience (he technically could have retired if he had wanted to) and I felt like he was very good at what he does and was very mellow as well.  He didn’t get all hung up in the vernacular of things and was good at seeing the bigger picture.  The new pdoc?  Well, he’s newish in his career and associated with a hospital (he’s on hospital staff) so he has to follow a bunch of criteria whether he wants to or not.  And he has to answer to a bunch of people whether he wants to or not.  And that can get kind of annoying.

For example, he does not like to use the term ‘bipolar’ and feels unsure that Rye really has ‘bipolar’ because after all, he has known us for all of 2 minutes now and do we, as a society, really know what bipolar looks like in a child?  So, he uses the term “Mood Disorder NOS” and gave us a whole mini lecture about it.  Dude, wtf, who the crap cares what you call it? If it makes you feel better to call it Mood Disorder NOS, go for it.   Call it ‘Der Wienerschnitzel’ if you want but let’s not mess with what’s working.    And honestly, let’s not debate what bipolar looks like in a teen.  If your child gets so hyper that they can’t attend school, can’t concentrate, make terrible decisions, engage in dangerous behavior, have no peace of mind, racing thoughts, racing speech, superhuman strength, can’t sleep, can’t relax, get delusional, get paranoid, hear things, see things, have debilitating nightmares…it’s not just a case of the ‘hypers’.  For peet’s sake.  Let’s not reinvent the wheel here.

Another thing, because this psychiatrist is on hospital staff, he has no say in his schedule.  In other words, we saw him for an hour for our initial appointment and going forward we will only be able to see him for 20 minute increments for med checks.  Even if we wanted to see him for hour long appointments and pay out of pocket to get more out of the experience or get more help, we can’t.  He’s not allowed to do that.   So, our fate rests in the hands of someone who knows us not at all and who really can’t get to know us either, even if we wanted to.  Even if we wanted to pay extra for it.  I don’t like the inflexibility of that.

Also, he asked for records.  All of Rye’s records from the dawn of time.  Why?  Because apparently he is going to look them all over and decide if all of these ‘diagnosing’ doctors (his colleagues with much more experience than himself) are right in their diagnosis .  And, because he says it will take their hospital staff 100 years to get the records if we leave it to them (not very reassuring), I need to do it all myself.   Apparently it is out of the question to just pick up the phone and call Rye’s previous pdoc for 5 minutes to get the run-down, colleague to colleague.  And to this end, getting Rye’s records is a pain but overall no big deal and all sounds good and great but let’s think about this…given the fact that we have now already had our allotted one hour appointment and from now on we get 20 minutes every month or up to every 3 months (our choice) to see him in total every year, this record seeking journey hardly seems worth my time.  When is he going to look these records over and when is he going to discuss his findings with us?  In the 3 hours total a year he sees us (of which we’ve already used 1 hour up)?  It’s never going to happen.  Also, he expressed concern that Rye’s learning disabilites may be causing his ‘bipolar’ like behavior.  Ummm, no.  Let’s not be ridiculous.  Learning disabilities don’t land kids in hospitals with crazy erratic behavior and audio and visual hallucinations, etc. etc, etc.

Anyway, the good news?  He is very nice and personable.  And I know he means well.  He appears to be a sweet person.  And Rye really likes him.  And he’s close to our house.  And he’s covered by insurance.  So, we’ll keep him in the running.  And, most importantly, he didn’t change the meds or even ask about changing them.  So that’s good.

Let’s not try and fix what isn’t broken.

_______

As for Dr. Stuart Kaplan and his Newsweek article, here are my thoughts.

Thank you Newsweek Magazine for your cutting edge journalism and breaking scientific studies but Dr. Kaplan is about 20-30 years late to this party.   Childhood bipolar disorder exists.   Is it common?  No.  Is it overdiagnosed and overmedicated in very young children?  Possibly.  But does it exist?  Yes.  And you don’t need an MD or a PhD to figure this out.  Ask any large group of adults with bipolar disorder when their symptoms began and many will tell you in childhood.  Period.  And most of these adults wanted help as children but no one believed them thanks to people like  Dr. Kaplan, propagating the idea that their symptoms were all phony or should be chalked up to something else.   Many of these children attempted suicide.   Some completed their suicide attempts and are no longer around to tell their stories.

Children with ADHD and/or ODD (and is this, ODD, really even a diagnosis?  people aren’t just assholes for no good reason, there is an underlying mood component to this) don’t experience psychosis.  They don’t experience visual and/or auditory hallucinations, they don’t experience incapacitating depression or attempt suicide, they don’t become homicidal, paranoid, delusional, experience thought dysfunction, hypersexuality, and on and on.  And the idea that we can fix these symptoms with stimulants as you would use to treat ADHD ??  Yikes.  There could not be a worse path to take.

And, as for bipolar disorder being trendy. When did this happen??  I can tell you from personal experience, tell people your child is bipolar and about the last response you will get is…’cool!   How can I get on that train? ‘

I know about 5 kids (children and teens) in total with bipolar disorder in our entire community.  And all of them have a direct biological relative with bipolar disorder.  In contrast, 1 in 10 kids now are diagnosed with ADHD.   Teach in any school in America and at least 10% (and sometimes up to 25%) of your class with be on stimulant medication.  Now that is trendy.  And sad.  You can’t tell me that 10%-25% of American children as young as 5 years old need to take speed to function and learn.

Ring, ring…

Dr. Kaplan, the 1980’s are calling and they want your professional opinion on childhood bipolar disorder…

Every teacher and tutor Rye has ever had will tell you very clearly, he has ADHD.  I know it, we know, his pdoc knows it.  It’s obvious.  And has been since he was about 5 years old.  He has a very short attention span when it comes to traditional learning and it takes a very patient teacher to teach him.

So, do we medicate the ADHD?

No, we don’t.

Why?

Well, we’ve tried.  A few times.  And we had good results for a few months and then ultimately had disastrous results.  Mania, psychosis, hospitalization.

With Rye having bipolar disorder and ADHD we choose to make a choice.  We have great stability now with the bipolar disorder and it took us over a year to get to this point.  Rye takes 2 medicines, Depakote & Seroquel.  Seroquel scares the crap out of me and I thank God every day that he is able to be stable on such a low dose (50mg).  I wish he didn’t need it at all.  That said,  there ain’t no way in hell I plan to add more meds to the mix and jeopordize that stability he has just so he can pay attention for longer to do schoolwork.  No way.  Forget it.  Not happening.

Does this make doing schoolwork hard?  Yes.

Does this impede his academic performance?  Yes.

Is this a contributing factor to us homeschooling him?  Yes.

Does it take great patience to teach him?  Yes.

But, so what?

To us, it’s worth it.

He is very active and we keep him very active in sports and other outdoor acitivities.  He needs and loves a lot of physical activity and a lot of time outdoors.

He’s happy most of the time, he’s healthy, and he’s living a very full, loving,  productive life.    That’s what matters to us.

The rest is just book work.

if Rye is going to have a hard time making good decisions for himself as he gets older.  And sometimes it really scares me.  It’s tricky because at times he can be such a  mature and astute kid and can make really good decisions, is a good conversationalist and seems to really have his head on right.  When we travel or are at dinner parties, gatherings, etc. he always gets compliments  from adults on how well he interacts with adults and they are always impressed with how outgoing, level headed and mature he seems for his age.  However, at other times you just wonder what in the blessed world he is thinking and why he makes the choices he does.  Especially after he’s been around a lot of kids his own age.  And even more especially when he’s around the kids from his [previous] school.  It’s like he loses half of his brain cells.  And I know a part of that is just being 13 years old.  And I know a part of it is just the intermittent immaturity of growing up.  But a part of it is just him as well.  He is so greatly influenced by his environment it’s incredible.  And it can be a bit nerve racking at times.

Nerve racking.

Because we really have to work hard to control his environment.  He is truly a chameleon that completely changes completely according to what environment he’s in.  I mean completely changes.   I’m just so glad he is out of public school.  He learned more bad stuff there then I ever could have even imagined.  It’s crazy.  And I know there are millions of kids that do great in public school and for them I am so happy,  but mine was just not one of them.

Definitely not one of them.

So, as you know by now, we have a few difficulties with the school Rye attends.  And that would be a gross understatement.  Without going back over it all, suffice it to say this is not the most enlightened, progressive, or proactive public school in the world.  Or, even in our county  (which, by the way, has a huge discrepancy as to the level of education, facilities and services they provide to different schools within the county, some of which are only 5 minutes from each other).  Anyway,  after complaining ad nauseum to everyone under the sun, writing endless emails, and generally becoming a thorn in the side of the county, we are now maybe, hopefully making some progress.  And as of yesterday, Rye now has a Behavior Intervention Plan (BIP) as a part of his Individualized Education Plan (IEP).

What is a Behavior Intervention Plan?  As of a few months ago, I had never heard of one despite the fact that Rye has had an IEP since the first grade.  Because honestly, up until now and before he attended Fast Times at Ridgemont Middle (lets just call his school this for now) he never needed one.  And, I’m sure even now in a different environment or a private school with small classes, he would not need one again.  Nonetheless, we must live in reality.  Fast Times is where we are now and the classes are huge and the special education support is lacking so this is what we work with now.

Anyway, back to the BIP.  The Behavior Intervention Plan is a federal legal document (as is the IEP)  that is included as a part of a student’s IEP.  The function of this plan is to identify behaviors that the student has as a result of their psychiatric diagnosis that interfere with his or her learning or the learning of those around them and then to help the child in a positive manner correct and replace that behavior.   It is also used to help the child stay in school for the full day and this helps with learning as well.

The most important thing about this plan:  It protects your child from inconsistent and/or improper correction or punishment from teachers or administrators.

And if you have a special needs child in a public school, this is something that should concern you. Particularly in middle and high school.

The Behavior Intervention Plan is a federal legal contract enforceable under federal law.

The BIP is based on a Functional Behavioral Assessment (FBA) that is performed by one’s school psychologist [note: the term psychologist is used loosely here because for public schools the psychologist is rarely a PhD but rather a master's level therapist, which in any other circumstance would not have the title psychologist].  The school psychologist observes the child over a series of days and different classsroom settings, talks to teachers, talks to administrators, and develops a plan of problem/targeted behaviors and then develops a plan for the teachers to positively and proactively help the student change these behaviors a little bit at a time.

Now, I’ll admit, having the luck we’ve had with this school so far, I was really hesitant to see what was going to become of these observations and discussions and how objective the school psychologist was going to be.  Luckily in the meeting, though, I found I was pleasantly surprised.  She seemed reasonable and neutral in her bias and that was nice.

So, why is this plan worth having?  Well,  it makes is so the teachers and administrators to have to follow a pre-determined and mutually pre-agreed upon plan of correction for undesirable behaviors and to help the child replace those problem behaviors with constructive, positive behaviors.  It keeps you child out of unnecessary and/or overused time in ISS (suspension) and from being randomly punished for behavior related to their diagnosis.   And this is something we personally have had a big problem with in our school.  Teachers over-punishing for small behaviors and punishing in whatever manner they see fit, without any positive anything coming from it  except anger, frustration, lost time in the classroom and an increasingly hostile environment.

Now, will this plan work?  Will the teachers and administrators adhere to it?  If previous and present adherence to the IEP without this new plan is any indication, the answer is no.

But we will hope for the best.  And prepare for the worst.  In the case of the worst, we will file for due process.

_________

Please note:  If you have a child diagnosed with ADHD and/or Bipolar Disorder, your child qualifies for an IEP with a note from your doctor stating the diagnosis under the category of Other Health Impaired (OHI).

A few weeks back a mom emailed me regarding her daughter who had been diagnosed as a young girl with bipolar disorder.  Her daughter is now grown but through a series of emails she shared with me a bit of history about her daughter’s struggles when she was younger with school and moods and their subsequent journey to heal her naturally.  Although I was fascinated with the information, I was a little overloaded at the time with our change to homeschooling and could not fully process the information.  Now I am adjusted to our schedule and am going back and looking deeper into the information she sent me.  She sent me some great information about thyroid function, vitamin processing (or lack thereof), nutrition and chiropractic treatment.   In the last email we exchanged she told me that her daughter felt one of the best things she did to help herself was upper cervical chiropractic adjustments.  So, I started researching this a bit.  Could this help Rye as well?

Here are some of the links and examples I found that say maybe yes:

Female, Age 8 years, Bipolar Disorder

At her evaluation, an upper neck injury was discovered. Her parents recalled that she fell out of her bed at age 2 and surmised that perhaps that fall was the source of their child’s neck injury. After undergoing the first upper cervical adjustment, no further adjustments were necessary as her neck healed and stabilized. In the first month, her parents reported some improvement in her condition but that her mood still fluctuated quite extensively. By the third month, her parents reported a substantial improvement in her mood in that she could easily handle situations that previously had set off episodes of mania, such as birthday parties, sleepovers, etc. In addition, they reported that she had also experienced improvement in her motor developement in that balance and coordination had also dramatically improved.

http://www.erinelster.com/CaseStudies.aspx?ConditionID=4

After 1 month of care, the patient reported an absence of seizures and manic episodes and improved sleep patterns. After 4 months of care, seizures and manic episodes remained absent and migraine headaches were reduced from 3 per week to 2 per month. After 7 months of care, the patient reported the complete absence of symptoms. Eighteen months later, the patient remains asymptomatic. CONCLUSION: The onset of the symptoms following the patient’s accident, the immediate reduction in symptoms correlating with the initiation of care, and the complete absence of all symptoms within 7 months of care suggest a link between the patient’s headfirst fall, the upper cervical subluxation, and his neurological conditions. Further investigation into upper cervical trauma as a contributing factor to bipolar disorder, sleep disorder, seizure disorder, and migraine headaches should be pursued.

http://www.ncbi.nlm.nih.gov/pubmed/15129207

Cases regarding epilepsy and add/adhd and autism.

http://www.839-7171.com/index.php?p=72138

http://www.839-7171.com/index.php?p=72134

Son with ADHD & Bipolar

My son Christian was diagnosed with ADHD at the age of 3. His behavior was very different from his twin sisters in that he was very hyperactive, impulsive, irritable, and was not able to focus. I had been bringing him to Goldsboro Pediatrics and was then referred to Greenville Psychiatrists. He was prescribed numerous medications such as Clonidine, Trileptal, Concerta, Abilifi and several therapists, including speech and behavioral. The edications seemed to help for a short time but the problems would return.

http://www.chiropracticadv.com/adhd-bipolar.html

Various case studies regarding upper c spine adjustments helping a variety of situations and symptoms.

http://www.upcspine.com/

Now, I am not saying this is going to work for us.  But there is obviously evidence that is helps some people.  And, as luck in on our side with this one, Don has a good friend who is a very successful chiropractor and we spoke with him about this type of treatment and he is going to research the specifics of it and try and help us. So we are seeking his help on this and start this week.

Who knows?  We may be one of people helped by this.  It’s worth a try.

Thanks Polly!  I am looking into the rest of your information as well.

[Note: the sculpture at the top of the post and others like it can be found at
http://www.theprofessionalcollection.com/Metal%20Creations/medical_figurines.htm ]

Homeschooling is going well for us.  Life is so much calmer now.  I am loving it.

It’s funny, though.  Sometimes Rye’s friends ask me why we are homeschooling now (in case you don’t follow the blog, we just recently went back to homeschooling after about a year in public school).  I explain to them that because Rye isn’t really like this (and they all know, he is definitely his own person):

Homeschooling gives us the freedom to be a little more like this if we need to (figuratively speaking, of course):

That’s cool, they say.

And then most of them tell me they wish they could homeschool too.

Who knew?

Normally I start my morning out reading a little bit of a certain pretty & friendly site to start my day.  The site is light, mindless, it’s beautiful,  and without conflict, pain, or struggle.  I find this very appealing first thing in the morning.   In fact, I’m a big fan.  I have to say, though, this morning when I read my morning dose it really got my goat.  Yesterday, like an idiot, I braved it and posted a comment in the homeschool section to the response of the question, what do you do to encourage reading with your children?   I posted how no matter what we do we can’t get Rye to enjoy reading chapter books as his memory, combined with comprehension, is so bad that he can’t remember one chapter to the next to make the book coherent.   Well, fine, good enough.  It’s true.

So, what was my big mistake?  I went back this morning and read the rest of the comments in that section.  They went something like this…

Well, if the children don’t like to read, it’s because the parents haven’t modeled that love of reading for them.

Wrong.  I love to read.  And write.  In fact, I read constantly and I write all of the time.  My undergraduate degree in is English Literature.  And I read and write in front of my child.  I have had writings published.  In the Library of Congress.  My child still does not like to read.  Or write.

If you read to your child as a young person at bedtime, they will have that love of reading instilled in them from a young age.

Wrong.  I read to my child every night before bed for years and years.  He still does not love to read.

I’m a reading specialist and I tell my students if they just push themselves in reading at higher levels, they will improve and love to read.

Well, you must be a ‘reading specialist’ in a public school because my son has had years and years of private tutoring from highly trained Orton-Gillingham tutors and while they have done a great job teaching him to read when public school reading specialists could not, he will still not pick up a book willingly and sit down and read it for enjoyment.  And my son’s reading tutors totally get that.  That is very common for kids with significant learning disabilities.

So, I’ll admit it.  I don’t have a perfect child who loves to read or loves to browse the library or bookstores and then cuddle up with a good book in front of the fireplace.  Despite the fact that I’ve modeled that behavior, we do it as parents and a family, we’ve all been to college and most of us graduate school etc., etc., etc.

Whatever.  Suck it.  My kid has enough personality and passion for life to fill 3 football stadiums.  He does not like to read.  Big whoop.

So, while the perfect parents of the perfect kids cheer themselves on for being wonderful role models and fostering great habits in their children, let’s hear it for the not-so-perfect parents of the world with the not-so-perfect, but miles and miles more interesting and entertaining, kids.

That’s right!

We have progress over here on the medical front.

I’m happy to say that we now have good insurance through Don’s work and we can start to make some progress with Rye.   This morning I took Rye to a new general doctor who was excellent.  He is doing a full panel of bloodwork including a full metabolic panel,  full thyroid panel (these may be the same thing but I know previously we got only the TSH which wasn’t even nearly enough so now we are getting the free t3, t4, etc.), all organ functions, blood sugar, vitamin levels, electrolyte levels, pretty much anything that could effect mood.  And this doctor is getting us a referral asap to the good Pediatric Neurologist in town to see about seizures and if that can’t happen in the next few weeks he is going to order the EEG himself and then we will just follow up with the Neurologist.

I am thrilled.  We are trying to rule out everything we can before starting on either Depakote or Lithium, just to be sure.   I would hate to put him on a round the clock mood stabilizer when there is something with a body system other than the brain itself that was causing the mood issues.  Or, if it is seizures we don’t want to use Lithium.  Anyway, you get the point.

In other news, we had a great weekend.  Rye spent the majority of the weekend with some friends of his that own a farm and they did work around the farm, fed the animals, fixed fences, etc.  That is Rye’s Shangri-La.  He loves working outside and wants to own a farm or ranch someday.  The kid could pretty much live outside.  That is where he belongs.  And with Rye at the friend’s house, Don and I had some relaxing time together Saturday and part of Sunday.  That was nice as well.

In not so great news, Rye had a very rough day today mood wise.  Rough on mom, to say the very least.  I’ll save that story for another day though.

I hope everyone had a good Easter.