Bipolar Child with bipolar

[anonymous]

I am currently caring for an 8 year old child. She is currently being assessed by a therapist. There is a tentative diagnosis of bipolar and possibly Cptsd.

I don't know to what extent. There has been on going domestic violence and drug use home.

I'm looking for some insight from anyone who has cared for a child with bipolar or ptsd.

What did a manic episode look like? How would you curb unacceptable behavior? At times she will laugh uncontrollably and be very rough / aggressive at the same time. Her behavior can become highly destructive. She won't allow a hug or any attempt to calm her. Distraction does not work. One Immediate concern I have is that she will harm herself or someone else. Suggestions would be appreciated.

 

[Queen Boudica]

Is it possible to diagnose an 8 year old with bipolar? That sounds way too young. Just bipolar diagnosis is becoming one of the most over diagnosed conditions. Is this a psychiatrist? Only a psychiatrist I thought could diagnose???

 

[anonymous]

No it is a child psychologist. She has not received a diagnosis just an opinion. I am not happy with the therapist. Find him to be insensitive and arrogant. But he has many years of experience with children and domestic violence.

 

[Queen Boudica]

I'd get a second opinion. That is a pretty serious diagnosis and often confused when a child has been abused. Just because he has many years experience does not make him right, especially if you are not happy with him.

 

[Justmehere]

Talk with the therapist for ideas how to help the 8 year old, you should for sure get a second opinion, and be slow to diagnose and/or medicate at this young age.

I have worked with a lot of children with a wide variety of mental health problems. Whatever is going on for this young child, be safe and be consistent. Don't push any hugs or physical contact. Communicate boundaries without lecturing or over-explaining or talking down at her. The more steady and calm you can be, and yet still be responsive and attuned, the better off for both of you. It may take some outside support for the adults around her too. It's tough to deal with a kid who is struggling, especially when they are at the point of possibly hurting themselves or others.

 

[anonymous]

I did some research of my own and she does fit all of the criteria for bipolar. Plus some other symptoms which don't fit. Although I'm aware that many symptoms overlap between disorders. I will seek another opinion.

Thanks @Justmehere I am taking a calm approach with her. Just working on the boundaries. Sometimes she is receptive, sometimes not. I just don't want to mess up.

 

[Friday]

Just to be aware... ADHD & Bipolar are sister disorders... Sharing so many symptoms that often the only way to distinguish which it is (and they never, ever, ever present comorbid, it's chemically impossible) is to admin a stimulant... And watch what happens. If they mellow out? It's ADHD. If they kick into a hell of a mania? It's Bipolar Disorder. It's slightly more complicated with kids... Because most kids do the 'over-tired' (screaming meltdowns / looks like manias) thing until puberty. In ADHD parenting circles, it's known as the "coke test" or "mtnDew test" etc. Because caffeine is such a mild stimulant, and can be given at very, very, low doses. But it 1/5th a can (to whole can) of soda = marvelous results, calm kid, finished homework? Voila.

When you toss a 3rd hat into the ring, like trauma, drug use, etc... It can become virtually impossible to distinguish what's what.

 

[Deleted member 1860]

I hope that you find someone who knows about attachment disorders. Many therapists don't understand attachment and label you with something else. (Been there...) I wish you the best.

 

[Friday]

Forgot to mention earlier, apart from wildly different medications (stimulants for ADHD are soothing, but trigger manias & mixed episodes in bipolar folks... And mood stabilizers & antipsychotics for bipolar disorder make ADHD people seriously unstable & psychotic)... A proper diagnosis is really important because the day to day & coping mechanisms for the two disorders are just as different. Case in point... The wild & crazies? In ADHD kids, you really want to encourage those. Rile them up (in an appropriate venue) and seriously burn energy, then switch to something that needs focus & concentration. But for bipolar kids? You do not want to encourage & ramp up manias!!! Also, foundationally, ADHD can learn emotional monitoring & regulation. We still have intense emotions, and often very swift swings, but we can learn to monitor & control those. Bipolar folk? No way in hell. Those are chemical swings into manias and depressions and mixed episodes that are not under the person's control. Sister disorders, but very very different treatments. What works wonderfully for one may well be the worst idea on the planet for the other.

Forum anonymity means we don't know your location... But if you're stateside, I know proper diagnosis is very expensive. First a full medical work up to rule out physiological causes or contributing factors. Which, sans insurance, is at least $250-$1000 including lab work. Then most psych evals (the "real" ones, 2 or more sessions, often 3-5 hours each) usually start at $750. A way to make that a little less difficult is to go through a developmental pediatrician/ pediatric neurologist (not a normal pediatrician, but in either case one who has an extra 5-7 years of schooling on top of their MD & Peds) ... So that you aren't doubling up on fees quite so badly.

Proper diagnosis won't just look at bipolar disorder (or PTSD, ADHD, etc.). It will run differentials for every disorder, including those that present comorbidly. As @Solara mentioned above, while one always has to rule out bipolar/ADHD when one or the other is suspected, there are a whole host of attachment & trauma disorders that would be equally likely given this kid's background & suspected Bipolar & PTSD diagnosis. Misdiagnosis wastes years and creates a lot of unnecessary pain & hardship... In what I'm sure is already a difficult situation.

 

[Tolkienian]

I agree that a proper diagnosis is important, but until then, I have some thoughts.

One: You are doing the absolute best you can do to care for this child. That's important--and even if she doesn't recognize that now, she might later. A caregiver who does their very best and gets it wrong is still *way* better than a caregiver who doesn't care.

Two: I'm going to give tips for teaching this little one grounding exercises, based on my work as a teacher of traumatized children and on what works for me (and my inner child). To my knowledge, I've never worked with a child with BPD before, so this is more for the CPTSD.

• Swaddling: I know that they make weighted blankets for kids with sensory problems or ADHD. For me, wrapping myself up tightly and cocooning myself reminds me that I am physically safe and grounds me in my body.
• The Hand Exercise: I don't know if this has an actual name. Basically, each finger equals a sense (sight, sound, touch, smell, taste). Then you count on your fingers 5 things you see, 4 things you hear, 3 things you can feel, etc.
• Breathing: Breathe in as you count to 4, breathe out as you count to 4. Or in for 4, hold for 2, out for 4, hold for 2.

All of these are easy enough for a child to do and give her something to focus on when she feels out of control. Possible next steps would be to engage her in a distracting activity or story or to talk about her feelings (somatic or emotional).

I'm wishing you, and the child you're caring for, all the best.

 

[Queen Boudica]

All good stuff what @FridayJones has written. Coming from my sister who was misdiagnosed with schizophrenia and drugged up like a zombie at 17 when what she was truly suffering from was trauma due to childhood abuse; that diagnosis and meds and her treatment in hospital traumatised her more and led to her eventual death. So get the best and most thorough evaluation and diagnosis possible.

Also worth checking if there is a history in her family of ADHD or bipolar. I know ADHD is genetic.