School issues

[Beverly]

My ds (ADHD, bipolar) has always had social issues but this year his bad behavior seems to have caught up to him. He is in 8th grade and the kids are not letting him live it down.

Yesterday he cam home and grabbed his sister's breast and told me to ____ off during a tirade. The therapist was on her way already so I met her at the door. He has been very imoulsive for over a week and then this, to me he had crossed over to manic again and I was ready to call the Mobile Crisi Unit because he had threatened to kill himself 2x.

The bottom line after almost 2 hours with her is that he has some problem or another in each of his classes. Yet he refuses to allow me to call the Guidance office since his counselor is on maternity leave and he "does not have a relationship" with the other counselor. I have no intention of caring whether he allows me or not, but am wondering if this was his was of explaining his behavior and avoiding a trip to the hospital.

The fact that I have been posting much more lately is usually a clue that things are not going well! Any advice at all would be very helpful. I have been attending a NAMI class on brain disroders and the facilitator seemed to feel he was hypomanic due to my exlanation on Monday evening.

[Beverly]

I called the guidance office this morning and he has been in there every other day! Let's see...some kids were bothering him by taking pics on their camera phones so he flipped them the bird and they took a pic of that so he got in trouble...some kids in lunch called him gay so he took something, stomped on it and then threw it accros the lunchroom and got detention...he had his collarbone fractured 2 weeks ago because a boy in gym tackled him during a flag football game in retaliation for something that happened...

What do I do to help him when he has a hand in some of the things that happen? It seems that the teachers and administration are ignoring some stuff because my ds has a habit of annoying everybody including the teachers. Any ideas on what I can ask the school to do? This is 8th grade.

I am considering sending him to private school for HS so he can start fresh with a new group of peers instead of the same 525 students who already dislike him but what can I do for this year???

[d]

Beverly so sorry your son and family are having a rough time of it.

What does the therapist say? Who else is he seeing for these problems? Two hours to calm him down, problems in all classes, social alienation, suicide threat (always serious) and the other stuff - holey moley.

What are they using to treat his BP? Seems like this may be the source for the majority of his problems so this is #1/immediate.

In the meantime or at the same time, I'd tackle the issues with the current school. Does he have a 504 or IEP for academic problems? Doesn't sound like they have an interventions in place (much less positive ones)? I wouldn't direct these questions to a guidance counselor, much less a sub counselor, more like the principal.

Does that help any?



(we miss your posts too)

[ohmama]

Beverly,
I am so sorry to hear what your family is going through. My first question would be the same as Mayleng... what meds is he taking? Obviously he is not stable, there is no question about that. The first priority should be a good look at the meds and what changes you can make with them. Is he taking an anti-psychotic as well as a mood stabilizer? I hope he is not on stimulants or SSRI's?

It doesn't look like he will be able to live down his reputation at school and a change of school's would help with that once he is stable is my second thought. This will give him a fresh start. Kids can be mean and not understand or care what he is going through and so not forget or forgive. The 504 or IEP is also a must. You probably already know this and have it in force but it should be looked at again for a provision that he can take a time out in a safe place and away from everyone when he feels "off". Could he cut back on the classes he is taking or the amount of work he needs to do to help with the stress he is having right now? A modified schedule or shortened day could help him till he is able to recover.

[Beverly]

Thanks so much for the kind words. He saw the therapist again today. It's usually twice a week for an hour each time. He also sees a Child Psych for med management once a month. She seems to feel it is the bullying causing him to act out or she said she would have called the Mobile Crisis Response Unit herself.

I must have really been upset this morning to have made that many typos on my first post. Unfortunately there is no sub guidance counselor-the 8th Grade Assisstant Principal is covering until they finally get a sub! She is AP and GC to 525 kids-sounds almost worse than what I am dealing with. I did say almost.

He is on Adderall XR (only 10mg), 750mg Depakote (250/500), 50mg Zoloft, and an Allegra 30mg chaser at bedtime. Without Adderall he cannot function even with the Depakote.

No IEP, no 504. ADHD dx goes back to first grade but only ever needed Corrective Reading. Without modifications he is an Honor Roll Student. He is in HS Geometry now in 8th grade. I tried to get a 504 last year and was totally blown off, and then he stabilized and summer came so I dropped it. He didn't even have a guidance file until the BP began to surface in 6th grade.

This is where I need help-he gets A's without modifcations. How do I ask for an IEP or 504 and stand my ground?

He normally saves the BIG stuff for me and his sister. The stuff in school is normally small but everyone finds out about it...stupid stuff...one of the boys whose mom had survived breast cancer had been dx with brain cancer and my ds asked him if his brother was going to get cancer since his mom breast fed him...went around town that ds told the boy his brother was going to die from breast cancer. The parents all know about this and when something happens, the parents do nothing if the situation involves my ds.

[d]

You've got me stumped - A's with no accomodations. The trouble he says has is in every class are all social/behavorial not academic, right? If he listed his troubles for each class, would there be any patterns like certain kids, times of day, teacher styles, anything? Did his grades slip at all this year?

I like ohmama's suggestions about a safe place, reduced schedule and/or workload at school.

::::thinking aloud here::::
Starting out fresh at a new school is a great idea, but I would want to know the root of the problems at current school and start addressing them before he has same at new school. However, I don't have much experience with BP which can be tricky so honestly don't know if that is right here. Also, the bullying thing really worries me - that can have devastating consequences for kids without ADHD/BP complications let alone the kids that do have them.

With many schools having zero tolerance for bullying, plus this is not the first time your school is hearing at least about the ADHD, a "disability" it seems like there should be some sort of way to leverage that - as in what are you school doing to ensure my son's protection so that he may recv an appropriate education bc currently NO protection is exacerbating his disability spilling over to all areas of his life?

Anyone that has experience with this, please help!

[ohmama]

Beverly,
Have you talked to the psych about this yet? There are several red flags I see concerning his meds that a psychologist or therapist cannot address. They are trained to look at what can be done on a level that can only work when the child is stable.

It is highly unlikely that the bullying would be the complete cause of his issues. They do play a big part but you must ask why the bullies are circling him right now? Not that they are justified but his unstable actions could be drawing attention to him and the bullies are always the first to respond. They are cowards and wait to find someone who stands out. They have found him to be easy prey. I doubt they can be stopped from what you describe. It must be awful for your boy.

I'm not sure if you have to be a member to access this information or not but the bipolar kids website has some outstanding information on what appropriate treatment guidelines are for bipolar illness in children and adolescents. It is found in the section called The Resource Center. Members of the site are encouraged to take a copy of this to their psych when deciding on medication treatments. Zoloft and Adderall are high risk activators even when a mood stabilizer is in place with bipolar. I'm not familiar with Allegra.

Here is the link...

www.bpkids.org/site/DocServer/treatment_guidelines.pdf?docID=441

You can join the site and become a member for free by requesting a fee waiver. They ask for $35 but it's no problem to get in free if you need to. Just send an email to them and request the fee waver form. The message boards over there are full of parents with problems that sound like what you are dealing with right now. By being a member you have access to those boards and can find great comfort in knowing you are not alone. The home site is

www.bpkids.org

When a bp child is unstable the priority is to check the meds. Things cannot fall in place without the med adjustments that may be needed first. It is impossible to reason with an unstable child in how he can avoid the bullies and the school is not equipped to do this either.

Almost forgot... Sorry d, I thought you were Mayleng and called you that in my other post. I guess when I saw the beach chair kid I thought it was her.

[Beverly]

d, we have been trying to deal with the social issues prior to this to avoid it being a problem in a new school. I have also explained to him that IF I do this, he is not changing schools again. The problems are all social, one kid is in both his Language Arts and Art and the Art teacher has stated that ds was bringing it on himself but has been doing better. It seems that the kid is now going after him in another class. The kid in gym is a non-issue since he is out of gym for 6 weeks. But there is another in Geometry and dozens in lunch. The only academic issue this year was hardheadedness that has him looking at a 68% in Honors Science-he decided he had studied well enough and I decided to let him learn the hard way.

I think I need to bypass the administration and deal with it one teacher at a time.

ohmama, we saw the psych last week but at that point all I was seeing was impulsive behavior. The therapist feels we need to deal with it as a situational issue before we start throwing more meds at him. She gave him some good tools today for dealing with the bullies.
I guess I'll give it a few days but not more than that and then call the psych.

Thanks everyone. Having more points of view helps a lot. I welcome all advice.

[carina]

Dear Beverly,
I am sorry to hear about your dillema.
There are a few things that is bothering me with your child. First would be a therapist at this fragile stage. Normally bp people does not respond well to psycho therapy when unstable. They do not respond well to any sense when unstable. When stable you might find the therapist is not needed so much anymore.
Treatment guides would be to first treat the bipolar and when that is stable the adhd component. Zoloft and Adderall separate or together could make your child totally unstable. I see no antipsychotic on board and that might be just what your child needs. Getting straight A's is quite possible for an unstable child. One of mine did when she spent half of the term in phosp. I would suggest you mention seroquel to your pdoc as it has very little negative effects. Then once you have him stabilised for bp, you can then add a stimulant in low dosage for the ADHD. But first stabilise the bp disorder. Zoloft can cause havoc in bp. We had full mania because of Zoloft.
As for changing schools. It is a good idea, but not before he is stabilised. He will just be in the same boat again, before no time.
Really hope you find a solution soon.
Carina
bpmom with bphusband with 4 bpchildren.

[Beverly]

Thanks so much for all of your input. Things were better Thursday-Today so it appears that the entire situation at school caused this and the therapist was correct. He had been stabilized since May and had started working with a therapist right before that. I have decided that changing schools is a definite, with it being very clear that he sleeps in the bed he makes, as it were. I really have to get at least a 504 in place because I was made aware that since ours is a regional hs district, I can make a case for him to be sent to another hs as long as I transport. That at least won't cost me thousands but still won't put him in a smaller school environment.

Carina, He didn't start the Zoloft until after he had been somewhat stabilized with Depakote. The psych never took him off the Adderall until 8 months after starting the Depakote, and then only for 3 weeks that was enough to prove he had to have it. It seems it was all situational, thank God!

[carina]

Hallo Beverley, My daughter was on Lamictal full dosage when the Zoloft was added. It took about 6 weeks before she went totally beserk one night. So a mood stabiliser does not gaurantee that ssri induced mania won't take place.
bpmom with bphusband with 4 bpchildren.

[Beverly]

Unfortunately my son was hospitalized last night. He ran away after beating up his sister but luckily he went to a friend of mine's house. He told her son that he was hearing voices telling him to do bad things and that he wanted to kill himself. Her 14 year old son was mature enough to know that he had to tell his mom. I hope they can get things stabilized better and don't send him home too early just because he is calm. I really would like to see him off the Zoloft myself.

[Mayleng]

Beverly. I am soooo sorry to hear that. Is your daughter OK? I hope the hospital can get him his meds sorted out and have him stabilized soon.

Take care.

[ohmama]

Beverly,
My heart goes out to you and your family. What happened to your son could very easily happen to any bipolar child. I'm glad he went to his friends house and was safe there. Sounds like he has a smart friend that knew just what to do. Give that kid a big hug!

Please look over this article and discuss with his psych the use of his Zoloft and the Adderall. His Depakote dose sounds low also. Do you know what his Depakote blood level was the last time you had it checked?

www.currentpsychiatry.com/article_pages.asp?AID=2735&UID=

I know you must be going through a million different feelings right now and I hope you will take some time to practice cognitive therapy, are you familiar with this?

Take care, we are here for you.

[Beverly]

My daughter is OK. A few bruises but OK.

Mayleng, his last Depakote level was 89. I read the info on the link right before the psych at the hospital called. He and I were on the same page, he was already planning to discontinue the Zoloft. He had already drawn for a Depakote level. He is going to set us up with a new psych when he is discharged, which is not expected for a week. He feels a short acting Adderall may be better.

Thanks for all of the support. It has been a rocky road and the ex and my parents have been very unsupportive. Luckily I have very supportive friends and great support personnel through the CMO (state program through the Children's System of Care Initiative). The support and information here have been invaluable.

I am very greatful that his friend did the right thing. Believe me I am greatful that he was smart and strong and did the right thing.

Gotta go and take his clothes.

[d]

Beverly so sorry to hear - for your ds, your dd and you.

Please keep us posted.

I have to say this - I'm only a parent, not a doc, nor do I have an ADHD/BP child - but I'm questioning the Adderall. Makes me uncomfortable - as a stim choice for him and using a stim when he's not stable.

Again, so sorry for all of you. My thoughts are with you.

d

[brazos]

Beverly,
I know it is so hard to deal with what you deal with every day. All I can tell you is I have seen some kids come out of psych hospitals so much better, this allows the doctors to fully monitor a patient. Take care of yourself and your kids!