Sunday, July 6, 2008

The Diagnosis, Part 3: Finally, We Got to Bipolar

In first grade, when Tommy was "suspended" from school, he received OT (Occupational Therapy) several times a week. (See The Diagnosis, Part II: SID and Feeling Like a Castaway: The Need to Build Community) At the time, we also started seeing a Behavior Therapist (BT), Nathan. I knew that sensory issues were not the only problem he was having. If you looked at the last year, he had moved across the country and had watched a woman he adored crumble to pieces. He had finally accepted his new school, and then it abandoned him by going bankrupt. Many children would have trouble coping with that. However, Tommy's classmates and brothers were having a much easier time letting go.

He would talk to us about getting a million dollars and reopening the school, and paying for his teacher's move back from Florida. He would come up with elaborate financial plans and draw designs for a new campus. (This might be a good time to mention that Tommy is very gifted in math). Nathan pretty quickly diagnosed him with an Adjustment Disorder, which lasts about 3-6 months. I agreed with diagnosis, and still do. However, we began to wonder why Tommy's behavior was still so severe well after 6 months. His sensory issues were improving, but again, not at the rate you would expect given how much OT he was getting.

In addition, we had a handful of other testing done. He had had a Neuropsych exam and testing, which revealed very little. She noticed he had an eye tracking problem and dysgraphia (like dyslexia, but with handwriting). Both of which are really OT problems. We saw a Behavioral Ophthalmologist to work in conjunction with the our OT, Becky to help his eye tracking issues. We also did something called Auditory Integration Training to help his overloads. Becky said that she had never seen a child, who was not Autistic, with such severe auditory overloads. His eye tracking was improving and his auditory overloads became noticeably less severe. Nathan was also working on Tommy's behavioral reactions to things that were not effecting him so severely anymore. Since he had learned how to react in negative ways to these stimuli, we feared he would continue to act negatively even if the stimuli were not so troublesome to him.

Four months later, in March, he was able to return to school part time. He was often able to have successful part time days, but more often than I would have liked, I got "the phone call." He was still raging and disturbing the other children, and he would only chose math work to do; no writing, language arts or social studies. He refused to go to Spanish, Art, and sometimes Music. He got very upset if he was not eating lunch with the same people every day, and transitions were still dreaded by both the teachers and myself.

As that summer progressed, Becky, Nathan and our family continued to work with Tommy in BT, OT and Behavioral Ophthalmology. We did all of these therapies at home, as well as in appointments with the therapists. We also changed his diet to include more protein and less carbs, especially sugar. I had a hair analysis test done on him to see if he was deficient in any nutrients. They recommended calcium, magnesium, zinc and fish oil. I also had complete allergy testing done, which revealed things I already knew, like certain kinds of pollens and cats. This felt like a 24/7 effort on many people's parts, especially mine. Yet, mid-summer Becky, Nathan and I looked at each other and asked, "Why are we still afraid to send this child back to school in the fall?"

It was the rages and rapid mood swings that most concerned us, along with his complete inflexibility and almost OCD like phobias over things he had decided were no good for him. Things like the kinds of foods he ate, where and when he expected to be somewhere, the tactile fears about creams, lotions, the wrong socks, etc. all still haunted him (and us). He could go into a rage so quickly that even a therapist as trained and astute as Becky would be taken off guard when suddenly Tommy would take the stretchy therapy band they were working with, wrap it around her neck and scream that he was going to strangle her and blow up the clinic if she changed her mind about getting to use the trampoline next. He would get so violent and angry at home, that I would have to lock him out on the front porch for fear he would hurt his younger brother. He would never run away, but always pounded forcefully on the door, screaming to let him back in. Finally, he would run out of steam, and I knew it was safe to bring him back into the house.

His (what we now know as mania) was also not being addressed by the therapies he was getting. His speech was rapid, interrupting him would cause great irritability and he became hyper-focused on particular and specific activities. All kids have favorites, but his were over the top - like obsessions.

We (my husband and our therapists) decided to take Tommy to a Psychiatrist for an evaluation. Becky and Nathan came with us so the Dr. could get the perspective from all of us and understand what kind of work and therapy Tommy had been doing. We met first alone with him, and then he met Tommy at the next session. He diagnosed Tommy with a mood disorder and put him on a mood stabilizing drug, Tegretol. We have since had many drug trials - good and bad. The question of whether or not to medicate your child is such a hot topic, and we have had so many experiences with it, that I will devote another posing to it.

As time progressed, Nathan began to take more seminars on childhood mental illness and brain research. He also did a lot more reading and research on the subjects. He shared a lot of this information with me. One day while we were doing play therapy at the park, I was reading about the symptoms of childhood bipolar. It hit me like a cast iron frying pan over the head. "Nathan," I pulled him aside, "this is SOOO Tommy!" It didn't freak me out at all. It was relief. There was a name for this behavior! Nathan had been thinking the same thing, but was counting, I think, on me to figure it out in short order. He was a little nervous, "Are you OK with this? Is this scaring you?" "NO," I cried, "he's still the exact same person he was five minutes ago, before this occurred to me. It doesn't change who he is, just how we might treat him. This could lead us down all sorts of paths we haven't explored before." So there it was - my child was Bipolar and I knew it. (We soon confirmed this with the Psychiatrist.) It was not shocking and terrifying. I just felt like we had taken one more leap, a rather large one this time, through the journey we were on with him. Though my feelings about it, and my level of acceptance with it, change all the time, I can remember feeling a great sense of relief in the park that afternoon.

1 comment:

Anonymous said...

I just wanted to note that despite your situation and that of many other parents with bipolar kids, there are many professionals who still believe that bipolar disorder in children is rare and almost non-existent. That is why it can take years for a proper diagnosis. A great book to read is "The Bipolar Child" by Papolos. Newsweek also recently had an article about bipolar disorder in children (it might have been in May, 2008).

Your determination to help Tommy is admirable and so impressive. Kuddos!