Bipolar Disorder/Risperdal/4 year old

Specialties Psychiatric

Published

Ok, so now the psychiatrists/psychologists are leaning towards bipolar disorder for my 4 y/o son. I thought he might be Asperger's but he doesn't fit that like he did when he was about 2.

We started risperdal 0.25mg QHS a few nights ago. He is really aggressive at times. Hurts others, himself, damages property...etc. I've tried all kinds of discipline, interventions, etc...and, I finally realized that he needs medication. That was an awful decision but if it makes his childhood better then it's worth it.

Any suggestions or info on risperdal in children? I've used it plenty of times on the elderly and mentally retarded but kids are different.

Doc told me to keep an eye out of tardive dyskinesia.

If you will read my first post on this thread, you will see that I have dealt with children with psychiatric issues. I am not one of those people who refuses to think that children can have these types of problems. I do think that it's important to think long and hard before putting a FOUR year old on lithium, risperdal, etc. And that's speaking as someone who put a THREE year old on Zoloft. You have to be sure what's going on before jumping into medications.

Also, what bloodwork is there for testing for bipolar? Never heard of such. I have heard of testing afterward for lithium levels and such, or is that what you were talking about?

No, if you will read my post again, you will see that I stated that there is NO blood testing available to determine bipolar disorder as some other illnesses may have. This is hard as a parent, because there is no cut and dry testing. Many parents of bipolar children spend years of their time, money and resources finding out what is wrong with their child. Bipolar disorder is not usually something that a parent wishes upon their child. It is not a diagnosis that is quick to be placed on a child that has a "behavior" problem or "lack of discipline".... it is not that simple. It is a diagnosis, that after many hours and sometimes many repeat appointments with a specialist that may become apparent. I, like you, however, hope that if a four year old is placed on Lithium (which, by the way is usually NOT the first choice of med for a child that age) there must be severe instability of the child and documented testing to support this fact. I feel very strongly about the rights of children with mental disabilities. My child has struggled with this "silent disease" for several years. It is sad, and heart breaking to say the least when there is not a clear cut form of treatment for some of these kids. I am just trying to educate the original poster about different options for her child and do think that it is a good idea for her to see an allergist to rule out an allergy that may be causing some of his symptoms. It is just that.... a process of elimination. I do hope that she gets some answers and will keep her and her child in my thoughts.

Specializes in Geriatrics, DD, Peri-op.
And that's speaking as someone who put a THREE year old on Zoloft. You have to be sure what's going on before jumping into medications.

And, I have resisted putting him on medicines since this all started about 3 years ago. Because of that, life has been hell...for everyone involved. I hate, hate, hate the fact that my child is on medicince and you can bet that if I find out it is something as simple as an allergy, he will be off of it in a heartbeat.

I took him to Early Intervention when he was about 2 to see if that could help him to increase his language skills...he was behind. I thought that might help lessen the tantrums. Then, he went to a program through Auburn University for the developmentally disabled. One of the last days that I went to pick him up after his day...the teacher was holding him while he was pitching a fit. She was crying, he was crying, and her chest was beet red from where he had been hitting his head into it. I took him to a child psychologist and she gave him a Dx of "speech delay". Let's see. Here were some of his symptoms at that time:

-speech delay

-unsociable-would not play with other kids

-head banging

-sensitivity to sound and touch

-fascination with "plastic bottle caps"...would not play with anything else

-did not play normally with toys

-rubbed his head across the floor constantly

-he seemed to get overstimulated in public

What does that sound like? Pervasive developmental disorder. I did research on that and he sure showed the signs of high-functioning autism. Unfortunately, no one wanted to "label" him.

The problem with not "labeling" a child is that they do not get the help that they need. We moved to GA (about 3 y/o)...his speech picked up...but, since he had no "label", there was no programs to help him. My hubby stayed home and I worked. We didn't think he could handle being in a day care with a lot of other children.

We moved to FL so I could finish my ADN (about 4 y/o). Then, my hubby moved to Bradenton. He thought he could handle my youngest while I stay here (pensacola) with the oldest to finish school. Hubby and his mom just couldn't do it. So, he was sent back here where I could finally get him in to a psychiatrist for some assistance. He is not showing the "autistic" signs that he used to but the aggression continues to get worse.

But, I had to do something. He is soooo aggressive. He's been hitting me, other adults, other kids, himself. He destroys property...whatever. I've had a busted lip from him before when he "head butted" me. A couple of weeks ago he started bashing his face into the wall when he was put in the corner and would not stop until my mom told him that his nose was bleeding. I've tried discipline and seriously if DFACS were to know how much I've spanked him, he would have been gone. I've even tied him to chairs while he has been in a tantrum to keep him from throwing things at the tv, throwing things at the wall, etc. Yes, I've been horrible to him...but, when you have a child that is screaming, tantruming, throwing things, and trying to hit you from the time he gets up until the time he goes to bed...you do things you never thought you would do. I even thought about putting him in foster care. I knew that I wasn't doing him any good and I knew he could feel my resentment. I've tried time-outs, taking privileges aways, positive reinforcement...etc. Nothing has been working. The kid DOES NOT care what you do to him. After 3 years, I FINALLY realized that.

He has had several major labs drawn on him as well to make sure his blood work is WNL...which are.

Now? Well, let's see. He's been on risperdal a little over a week. My hubby is here for a visit and notices a difference in my son since he's been on risperdal for the past week. My mom (who I live with) does, too. He hasn't tried to hit anyone in several days....and he is not "being so mean".

Like I said, I hate the fact that he is on medicine, but, I think that I did things the way I should...I used it as a last resort. Please don't be judgmental. I'm a mom trying to find the best way to deal with my son. I can't tell you how many times I've cried telling my hubby that I can't live like this until he's eighteen. I am doing the best I can.

I really hope that we can find out that it is an allergy...but, I am not so sure about that. If he is NOT allergic, then I want to find a medicine that is not so rough on kids. The problem is that not enough research is being done on children with some of these issues. It's making ME want to go into research myself.

Anway, it's long...but, a little hx helps you all. And, if there is one thing that I have learned, don't automatically assume when you see a "bad" child that it is because of lack of discipline. I can assure you that is NOT the case with my child. He has a medical/psychiatric problem. You can tell in public as well by looking at the mom's face. Mine would have a look of frustration, embarassment, and desperation when he would start screaming at the top of his lungs in a store.

Thanks for you guys' help.

Specializes in Geriatrics, DD, Peri-op.

I guess I'm not sure if I should have gotten so personal. This is just a touchy issue for me. And, if it helps someone else, it's worth it.

For the record, I do NOT spank my child anymore. When I realized his problems were medical in nature...well, how can I spank him after that? :o

And, I have resisted putting him on medicines since this all started about 3 years ago. Because of that, life has been hell...for everyone involved. I hate, hate, hate the fact that my child is on medicince and you can bet that if I find out it is something as simple as an allergy, he will be off of it in a heartbeat.

I took him to Early Intervention when he was about 2 to see if that could help him to increase his language skills...he was behind. I thought that might help lessen the tantrums. Then, he went to a program through Auburn University for the developmentally disabled. One of the last days that I went to pick him up after his day...the teacher was holding him while he was pitching a fit. She was crying, he was crying, and her chest was beet red from where he had been hitting his head into it. I took him to a child psychologist and she gave him a Dx of "speech delay". Let's see. Here were some of his symptoms at that time:

-speech delay

-unsociable-would not play with other kids

-head banging

-sensitivity to sound and touch

-fascination with "plastic bottle caps"...would not play with anything else

-did not play normally with toys

-rubbed his head across the floor constantly

-he seemed to get overstimulated in public

What does that sound like? Pervasive developmental disorder. I did research on that and he sure showed the signs of high-functioning autism. Unfortunately, no one wanted to "label" him.

The problem with not "labeling" a child is that they do not get the help that they need. We moved to GA (about 3 y/o)...his speech picked up...but, since he had no "label", there was no programs to help him. My hubby stayed home and I worked. We didn't think he could handle being in a day care with a lot of other children.

We moved to FL so I could finish my ADN (about 4 y/o). Then, my hubby moved to Bradenton. He thought he could handle my youngest while I stay here (pensacola) with the oldest to finish school. Hubby and his mom just couldn't do it. So, he was sent back here where I could finally get him in to a psychiatrist for some assistance. He is not showing the "autistic" signs that he used to but the aggression continues to get worse.

But, I had to do something. He is soooo aggressive. He's been hitting me, other adults, other kids, himself. He destroys property...whatever. I've had a busted lip from him before when he "head butted" me. A couple of weeks ago he started bashing his face into the wall when he was put in the corner and would not stop until my mom told him that his nose was bleeding. I've tried discipline and seriously if DFACS were to know how much I've spanked him, he would have been gone. I've even tied him to chairs while he has been in a tantrum to keep him from throwing things at the tv, throwing things at the wall, etc. Yes, I've been horrible to him...but, when you have a child that is screaming, tantruming, throwing things, and trying to hit you from the time he gets up until the time he goes to bed...you do things you never thought you would do. I even thought about putting him in foster care. I knew that I wasn't doing him any good and I knew he could feel my resentment. I've tried time-outs, taking privileges aways, positive reinforcement...etc. Nothing has been working. The kid DOES NOT care what you do to him. After 3 years, I FINALLY realized that.

He has had several major labs drawn on him as well to make sure his blood work is WNL...which are.

Now? Well, let's see. He's been on risperdal a little over a week. My hubby is here for a visit and notices a difference in my son since he's been on risperdal for the past week. My mom (who I live with) does, too. He hasn't tried to hit anyone in several days....and he is not "being so mean".

Like I said, I hate the fact that he is on medicine, but, I think that I did things the way I should...I used it as a last resort. Please don't be judgmental. I'm a mom trying to find the best way to deal with my son. I can't tell you how many times I've cried telling my hubby that I can't live like this until he's eighteen. I am doing the best I can.

I really hope that we can find out that it is an allergy...but, I am not so sure about that. If he is NOT allergic, then I want to find a medicine that is not so rough on kids. The problem is that not enough research is being done on children with some of these issues. It's making ME want to go into research myself.

Anway, it's long...but, a little hx helps you all. And, if there is one thing that I have learned, don't automatically assume when you see a "bad" child that it is because of lack of discipline. I can assure you that is NOT the case with my child. He has a medical/psychiatric problem. You can tell in public as well by looking at the mom's face. Mine would have a look of frustration, embarassment, and desperation when he would start screaming at the top of his lungs in a store.

Thanks for you guys' help.

Michelle,

I just wanted to let you know that I have been in your same position. It is so hard when you have a child that is so unstable. Have you thought about inpatient care to get him stabilized? I am sure that you have because most of us with a child that has such severe mental issues have. It is a hard decision, but sometimes can be the best thing for our kids. I have been in the same spot as you as a Mom when I thought that punishing my child was the best thing. Now, that I know that he has a mental illness, I am much more understanding. This doesn't mean that I agree with his outbursts and such, but at least I have the peace of mind that he has a medical reason to some of his behaviors. The symptoms that you describe really sound like autism to me. I have learned that perseverence is the key in getting these kids the help that they need. I kept a daily mood log for my son for about 6 weeks. This log, along with testing done at the schools tremendously helped with getting the right diagnosis for my son. Before being on the risperdal, my son was suicidal and attacking his brothers daily. He would have outbursts that I cannot even explain how dangerous he became. I feared for my other children as well as myself. He even stated that God was telling him to do these things and that he must do them or he would go to hell. It is hard, as a Mom, I have spent many nights crying wondering why he has to suffer so much. It was hard at first when my son was placed on a psychotropic med. I hated the fact that he had to take such strong medication. But, after I realized, that my oldest son who was born with a complex congenital heart defect had once been treated with meds for a medical need......this is no different with my son who has a mental illness. There is a need for the meds. These persons with mental illness have chemical imbalances and they must have their meds in order to cope. If my son does not have his meds, then he suffers. He states that he feels as if he is going to explode. He has flight of ideas and cannot focus because he hears voices as well. I have an aunt that has been bipolar for years and she is very stable. She cannot go without her medication or she becomes very cyclic. She has told me that it is like a living hell when she is not on medication. She cannot make a decision because her judgement is impaired when she is not stable. She cannot hold a job or take care of herself when she is not stable. It is such a hard thing as a parent to see your child have to be ill with any type of mood disorder or mental illness. It is also hard as a parent when my oldest son has had heart procedures, family and friends send cards and stop by to give us their well wishes. But, when my second son is unstable and has problems with his illness, no one wants to talk about it because it is taboo. I just hope that as our children get older that mental illness will be more "socially acceptable" for their sakes. Please, if you ever want to talk, you can pm me anytime. My thoughts are with you!

Hugs

Specializes in Med-Surg.

I hope you don't think I was being judgmental. I certainly wasn't meaning to come off that way. I think for certain things--PDDs especially--early intervention is the only way to make a major difference in outcomes. I just think that using Risperdal as a first line choice of med for a child of that age is quite drastic. Heck, read some of my other posts--I HAVE a child who has been on Risperdal and Geodon for YEARS...he started developing side effects that were severe enough that we decided to go without and deal with the behaviors instead--being a 13 year old male with puffy nipples and arachnoid movements is absolutely unacceptable.

I will not post any further to this thread as I think my POV is being misinterperted. I was hoping that my experiences would be of some use to you, but instead I seem to have made you feel guilty or angry or something else.

Specializes in Geriatrics, DD, Peri-op.

Yellow Rose, he is not at the point that I feel he needs inpatient care at this time. He was headed that way, but, I think the meds are making a difference. The worst was when he was between 2-3. My hubby and I lived in a town with no family and he was severely tantruming on a daily basis. Now, he still tantrums...just not all the time. However, he is becoming more violent towards others.

He seems to be really calm on the Risperdal though. He is not so quick to "pitch a fit". We are due to go back to the doctor in a week and I plan on discussing whether or not there may be another med with less side effects that we can try.

Thank you for letting me know you've been there. There have been alot of times that I felt so alone.

Panda, I did not mean to offend you. I just wanted you to know that it was not my first thought to put my little man on meds. I know, as well as you, that many parents look for something for their kids so they don't have to deal with them....maybe they don't want to discipline them...maybe they don't want to really put in the effort it takes to be a parent. I don't know. What I do know is that I want my son to be as close to normal as he can be. If that takes meds, then I have to do that. And, yes...I have some concerns over risperdal. The day the doctor decided we should try it, I came home and started reading up on it. It scared me. I plan on seeing if we can try something else with minimal side effects. The problem is with ALL meds there are side effects and you have to weigh those side effects with the behaviors of the child not being on meds.

You took your child off of medicine. Let me ask you how he acted. Was he violent? Did you have to try something else?

Please don't leave...let's get whatever we need to aired out. These are our children we are talking about. We can help each other.

Specializes in Med-Surg.

You took your child off of medicine. Let me ask you how he acted. Was he violent? Did you have to try something else?

He has been violent, usually directed at one of his siblings. We have been afraid for them at times because he gets out of control. The root of his violent behaviors when they occur is paranoia which is what the anti-psychotics were mainly treating in him. For example, the 5 year old knocks on my oldests door and wants to go in. All goes well for 2-3 minutes until my oldest decides that the 5 year old is trying to take something from his room. Never mind that the kid is just sitting on the futon watching what's going on. Then someone gets hurt. Solution--my other kids aren't allowed in my oldest child's room, and he isn't allowed in their rooms with the door shut. They have to be pretty closely supervised to prevent problems. We also explain why his behavior is irrational to him...seems like every once in a while he is able to make himself realize that now, but it has taken years of work.

He is currently taking Abilify. He was off antipsychotics for 6 months, and that was all that we were able to deal with. We have to watch him pretty closely though since he developed TD on Geodon, it makes it more likely he could develop it again on other meds. He is also on Lexapro and tenex for anxiety and OCD behaviors. He has been on stimulant medications for years but we stopped those about 2 months ago and have seen little change in behavior since stopping them. His diagnosis is Asperger's Syndrome. Diagnosed at age 7 at University of Tennessee. Prior to that we had been through numerous other diagnoses and one round of inpatient treatment. We have tried every diet, behavior therapy, some crazy random eye-movement treatment...

I worry about what problems we are going to have in the future because of the meds...we have been told to give him only sugar-free drinks because of the increased risk of diabetes in kids that are on anti-psychotic meds. Of course there's TD to worry about and gynecomastia. Not to mention the other 2000 things listed in the PDR.

Good luck in whatever you decide to do. I know it's hard to make a decision about how to treat your child.

Specializes in Geriatrics, DD, Peri-op.

Thanks for sharing that with me, Panda. I know it is hard for you.

My son does not really fit in the autism spectrum disorders anymore. Which is so odd because he DID fit PDD between the ages of 2 and 3. I just wish I knew what was wrong with him.

I worry about what problems we are going to have in the future because of the meds...we have been told to give him only sugar-free drinks because of the increased risk of diabetes in kids that are on anti-psychotic meds.

Yes, I'm trying to curb his sugar intake, too. Although I think his appetite is picking up a little.

What do you all know about lithium? Is it worse than the risperdal? Have any of you had yours on it?

First off, let me say that I am not a nurse (hopefully will be able to get back to school now that son is stable), but a mom to an 11 year old with the diagnosis of bipolar. I'd like to share my story with you and maybe offer a suggestion or two.

My son was diagnosed with bipolar last year. We tried many different medications, hospitalizations, and even thought we would have to place him into long term care. Things were bad. He was very violent, hallucinating, not sleeping...it was just awful.

He wasn't getting anywhere. His psychiatrist was baffled by him and on the verge of referring him to another psychiatrist. I was getting desperate. I started researching trying to find out what was wrong with this kid. I looked into Autism. I looked into Aspergers. If it was a disease or disorder, I was reading about it.

Finally, I asked for a CAT Scan. I wish I had done that years ago. The psychiatrist called me a little later to tell me that he had calcification in the left temporal lobe of his brain. She referred us to a neurologist and after a few MRI's and several EEG's, we had a new diagnosis. My son had had a stroke around the left temporal lobe area and this brought on his bipolar disorder. He also had a mass around his left temporal lobe referred to as an angioma. In his case, Dr's 'think' it is a Venous Angioma and that he was more than likely born with it. He also picked up the diagnosis of epilepsy. He is now being treated with Lamictal and Abilify and doing much better than he has ever done. We still have problems, but I never thought he would be doing as well as he is right now. There is hope! Don't give up.

My suggestion would be to think about getting some kind of testing done like this just to be on the safe side. I wish I had done it sooner. It didn't change anything, but allowed me to understand why he was the way he was.

I'd also like to direct you to a website from the Childhood and Adolescent Bipolar Foundation at this address: www.cabf.org

This place was a Godsend to me when my son was so unstable. This is a very busy site and you will read about lots of things that sound all too familiar. You will even meet many parents whose children have several disorders such as Autism and Aspergers as well as bipolar.

I hope this will be helpful to you. I understand your desperation.

Blessings to you and your family.

Specializes in Geriatrics, DD, Peri-op.

Thank you angelwings...you are already on your way to being a good nurse. :kiss

Michelle, you might look into regulatory disorder or sensory-regulatory disorder. There are 3 or 4 subtypes and I'm wondering if your little guy might fit the criteria.

Specializes in Geriatrics, DD, Peri-op.

lucianne, thanks for that tip. :)

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