"Normal" hyperactivity vs. mania?
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| Wed, 07-05-2006 - 5:07pm |
Ok, I am sure this is going to sound overly dramatic but DS has been over the top with hyperactivity, crazy silliness, and little sleep for the last 2 weeks. It is about to drive me crazy. He is really "happy" but in a wild, silly way. I've never seen him like this before and I can't figure out why or what is happening.
So, being the worrier I am, my thoughts go back to the possibility of a mood disorder or bi-polar. Eric is 4 w/PDD-NOS dx. A few months ago he was very prone to emotional outbursts similar to what Evelyn described in her recent post. He would get frustrated, then throw things and hit us. Following by inconsolable crying and saying things like "I don't love myself. I hate myself." At this time he also had real OCD problems. Eric is adopted and depression and bi-polar run in his bio family.
If you recall, we took him to neuro, who suggested SSRI's but wanted us to see a psych, who said check out all the physical problems first. We discovered GI problems and once we fixed those the OCD's and anger fits totally stopped. I had convinced myself it was the GI troubles making him anxious and the stressor for his outbursts and OCD.
Fast forward to now. I am wondering if instead, he was in a "depressive" state and now in a manic one. He gets up at 5 am (unusal for him) no matter how late we keep him up. This has been going on for two weeks. He is constantly talking, but often it is silly, talking in funny voices, laughing, being a clown. He has no attention span, is jumping all over the place.
So I increased OT stuff. It hasn't really made a difference. I talked to the OT who thinks it is just a summer thing, that behavior often deteriorates when routine changes. But the routine changed over a month ago. It is the same now. If I didn't know better I'd say he'd had some gluten, but I am pretty sure he has not. I've checked with camp (they put bracelets on the GFCF'ers). I don't think that is it.
So my question is how do you tell if this is something more than just regular ASD hyperactivity? The silly talking laughing thing is new to me. I know mood disorders don't usually show up this young.
Any thoughts? Should I just wait and see if I can find out more of a pattern? What would you do and what do you know about mood disorders in young kids?
I'm having a real problem keeping patience with him. The ST suggested designated a time of day as "silly time" and using that to keep him on track. ("It's not time now to make faces and hiccup, but you can do it all you want at silly time." Or something.) I'll try that first.
Just wondered any ideas.
Katherine

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Mood challenges and lability are common with ASD just like OCD traits or tics. It is kind of often part of the whole package. My doc steers clear of giving co-morbid diagnosis to go along with the DSM's stipulations. She tells me that it comes down to which is the most significant area of need and that is the diagnosis. Kids can have all sorts of different issues under that diagnosis that need treatment based on the individual child. And you need to look at the whole picture.
I think lots of docs have different oppinions but hers does coincide with what the DSM says and it works for me.
That being said, Mike has significant "mood" issues. Mood disorder has been mentioned however, I don't agree he has a mood disorder because I feel his mood issues stem straight from his autism symptoms. Plus though Mike goes through hypermanic, he has never gone through a "depression". I would think Dave the more classic BP type but I am still holding out hope. We have tried a mood stabilizer for Mike and it was a disaster, however, I have used some similar BP type interventions and keep that in mind.
Eric is on Omega 3's right? Have you changed the dose at all? The nice thing is there is an actual medical study showing the effectiveness of Omega 3's on people with bipolar so it is a good place to start. However, after a while it started to backfire on us. I think Mike's system was saturated with as much omega 3 as it needed at the time so we nixed the supps and tried to increase omegas naturally in his diet (adding flax, etc). That seemed to help for a while. I may need to put him back on soon but I could definitely tell when it got to a point that we needed to take a break from them for a while.
I have not figured out what the difference is between hyperactive and manic myself but I have had folks tell me at times that my boys can be manic. I think when Mike gets to the point that he just can't stop and his ears turn off that he is hypermanic.
Mike has cycles (particularly at 4 I remember them clearly) as well as quick mood changes during the day. I did notice that his "cycles" tended to center around different changes that took him along time to get over. For instance, school breaks, starting the beginning of the school year, christmas. It was like clockwork. The first week after such a change he might do well and then he would have a bad cycled for a few weeks then go back to being pretty much his usual self. So at the end of the school year we get about a good week, then he goes through a few weeks of being a royal poopoo head, then pretty much normal mike. Same when we moved, or any other major changes. That is why I think his is related to his ASD. His daily mood lability is often related to sensory issues, anxiety, or changes or the video games.
That is my experience anywhoo.
Renee
Thanks, Renee. I am not doubting his ASD. I am sure that is the "primary" dx, but as he is still so young, I have a lot to learn. The co-mordbid stuff is confusing. Maybe I should increase the Omegas. He does get a lot through food, but has been on the same supplement dose for over a year.
But I popped over to the Child BP board (hi, Dee!) and the whole "cycling" thing, plus what you said, interest me. Eric's "depressive/OCD" episode was in the winter. It started when we visited my folks in West Virginia for two weeks in November. Different everything than Florida, and it continued through April when we finally visited the GI and got his colon problem on track. All's well until now. School got out last week of May. Eric was sick a week, then started camp. Seemed fine for a week or two, then started this hyper stuff. This also coincided with the start of the "rainy" season in FL.
So I am wondering about the seasonal influence. Maybe that is part of it, like you said, the routine changed and so did the seasons. In Fl, the seasonal changes are kind of subtle, but they are there. And if he is sensitive to atmospheric pressure changes (I know this is out there, but that is the big difference with the "rainy" season coming) that could have all kinds of sensory ramifications.
I know I'm all over the place. If Eric has some mood thing, it is definitly comorbid and secondary to his ASD stuff. But what to do about it?
Thanks for your thoughts and if anything else occurs to you, let me know.
Also, how do you as Mom cope with these cycles? Besides wine, which I have with me right now! LOL!
Katherine
Hi Katherine,
This section of previous post caught my eye --
"School got out last week of May. Eric was sick a week, then started camp. Seemed fine for a week or two, then started this hyper stuff. This also coincided with the start of the "rainy" season in FL."
I have a feeling that you are thinking he should be done with reactions to transitions ... Hmmmmm. Has he ever done this camp before? Is everything there working well for him, is he happy during camp? Lots of new people, new kids, new routines, right? I would still think after ending school -- a week sick, ALWAYS harder for our kids and reaction can list longer than just the recovery, SCARY being sick --- then a NEW CAMP! He very well may not calm down for a bit longer and you could still just be looking at "normal" ASD reaction to great big change!
Sometimes they hold it together for awhile and then have the reaction.
Just my thoughts.
Sara
ilovemalcolm
Katherine,
I have no advice for you, but I wanted to let you know that we are going through the EXACT same thing at our house! Sylvia, also 4, also dx PDD-NOS, is going through a very strung-out phase. She's also waking up at 5am regardless of when she goes to bed, and we've started putting her to sleep at 7pm just so that she'll get a decent night's rest. Even so, she's exhausted by mid-day, and that's when her "manic" stuff starts: laughing hysterically, misbehaving and laughing at the same time, being aggressive, sudden mood swings and tantrums, you name it. We've been chalking it up to being overtired and sleep-deprived, in addition to the change in the seasons and the change in schedule. We're hoping (DESPERATELY) that once she's caught up on sleep a bit, her mood will even out and make everything else easier to handle. I think that the change in temperature, the switch from long sleeves/pants to short sleeves/shorts, all the morning light, etc. have really thrown her for a loop, but hopefully she'll adapt to the Summer season before too long (and before Fall arrives, lol!)
I've also found that the only thing that will really calm her down is deep pressure. We've had to stop brushing -- she squeals as if I'm tickling her, even though I'm using the same pressure with the brush I always have -- and instead do "squishes" to her arms and legs, shoulder presses, deep back rubs, etc. That does seem to calm her down and organize her a bit (as does a long stretch of time on the potty with a book, incidentally!)
In terms of how to cope, I'd love some suggestions myself! So far wine is all that's worked for me, in addition to putting her to sleep at 7pm (with melatonin) so that DH and I get get some peace and quiet for a few hours before bed. So anyway, I know I'm not much help, but I definitely can relate, and I feel your pain!!!
Jennifer
It definitely could be any number of things.
I think the point I danced around was that mood issues are extremely common amung ASD kids regardless of whether or not they have full blown mood disorder. And since they can have mood issues some of the same interventions work for them (ie mood stabilizers, etc). Kind of like ADHD. I would dare say a good percentage of ASD kids I know also fit the diagnostic criteria for ADHD but is it true ADHD or similar symptoms caused by ASD stuff, KWIM? For some kids with ASD and ADHD symptoms ADHD meds work, for some it is a disaster.
But you could also try omega's first since there is good research into the effectiveness on them with mood disorders. What about if you cut back on the omega supps for a bit and see if that helps? I have heard that sometimes flax in particular can cause mania or perhaps his body is saturated and needs a break? I am just guessing. I can't even remember what I read where I thought it was a good idea to take a break for a while from omega's.
I wonder if the mania has anything to do with being out of school and off routine? We have been swimming almost daily and that has helped the mania here but without getting them out and doing something completely EXHAUSTING at least a few hours a day they go off the deep end with hyperness. On regular days it isn't like I let them sit home and watch TV all day. They will play outside alot, etc but it isn't enough. I notice a real difference with the swimming.
Good lucK! I understand where you are coming from though. Dave still has a few ASD type traits but the mood traits are kind of over taking them. He does well in school but I am getting concerned about him again. He can be happy as all get out then if something doesn't go his way he becomes incredibly sullen, oppositional and even weepy. OVER the stupidest things. Last night it was because he had somewhere he wanted to sit for the fireworks and DH and I had unknowingly chosen a different (larger) spot. It took a full 20 minutes of him sulking before he would sit with us. He will go from completely hyper and doesn't even connect with what you are saying because his brain is going 100mph to this sullen thing where he won't talk to you, moping, and hides in his room. It is starting to make me a bit nuts. I am thinking of starting up omega's with him again.
Renee
My daughter (who will be 4 next month) is the queen of silly voices and wacky, hyper behavior. She has a dx of pdd-nos and an endocrine disorder, and is basically just a handful. There are times when she literally cannot remain still, and this is generally some part of every day. She has an exceptional attention span at other times, so ADHD wasn't considered.
I can tell you that she's the most hyper, and the most sensory seeking when she's over tired. If your son isn't sleeping a lot he may be creating a self-fulfilling cycle. In you position (knowing what I do about Kivrin) I'd try to enforce some more quiet time before seeking further intervention. When Kivrin goes on her no-sleep binges I go exactly the opposite way on bedtime than you suggested. She generally has to go to bed at 8:00 even if she stays up until midnight talking to herself. When she's doing the midnight thing a lot I put her down by 7:30 and don't let her out of her room until 6:30 the next morning. And I make her have some "quiet time" in her room in the afternoon. Generally within a few days to a week she starts sleeping again and the behavior starts to improve. Then I get back to being a little more in step with her cycles for sleeping and waking.
I don't know why this happens with her, but sleep disturbance is very cyclic with her. Right now she's overtired from swimming today and not taking a nap. She's been bouncing off stuff and babbling in incoherent syllables for an hour or so. She's feeling tired now though and just doing some self stimulatory stuff like rubbing her face all over the dog gate and walking with a bizarre posture while sucking her thumb, pulling her hair, and balancing tip toe.
Mary
Katherine,
That's a tough one. When our David was dx with Asperger's and "mood disorder not-otherwise-specificied", the dev. ped. told us that the reason she was adding that extra diagnosis was because, A) we had described a few episodes of possible psychosis, and B) we have a family history that probable mood disorder.
For us, there was an element of scariness to the whole thing. I was afraid for David's safety. He never had any "cycles" that I could discern, but kids with BP often have mixed states, where they are manic AND depressed at the same time. His "goofiness" often included talk about self-mutilation. I even kept a chart where he could earn a star for each day that he did not talk (and mimic, in a loud way) about chopping up his butt with an ax. Five stars and he'd get a new Bionicle, the greatest treasure of all. He never could do it. It's hard to believe that I still didn't GET that he couldn't help it. The goofiness threw me; I thought he was testing us. After a while, the goofiness started to be replaced with hostility and talk of wanting to die. (This is a kid who didn't have even a hint of a tantrum before the age of three.) It doesn't sound like that's the kind of stuff you're dealing with. Then again, each kid is different.
You might want to check out www.bpkids.org to see if any of the info there rings true. Unfortunately, you need to join ($30) to read and post on the message boards, but there is plenty of info that you can see for free.
Evelyn
Hi Katherine,
Liam was dx with the mood disorder first (age 4)and the AS (5)
You could be right, Sara. He has not been to camp before and it is all new. Ironically, it will end in 3 weeks, probably just when he gets used to it! LOL! I had originally planned to have him do a sort of smorgasboard of camps, one week gymnastics, one week pragmatics, one week art camp. Now that I see the reaction, if this is the reason, I am glad I kept him at one place--and a therapy-oriented place-for the whole summer.
He did say what he liked best about camp was coming home and that "it will be the greatest day when I go back to my regular school."
He does tend to hold things together during the day at school and at camp, then let them out at home. The ST and OT who run his small group say he is doing beautifully and they are surprised by my observations.
Maybe that is it. This is just different than anything I've ever seen him do before, and more extreme.
Katherine
This thread interests me as both Peter and I have mood lability. My sister was DXed BP, but now they are questioning if they were right on that on (?). My shrink does not think I have BPD but does not question that I am a moody cow!
visit my blog at www.onesickmother.com
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