Status of the new order

Day one, the boys did mostly well with the lack of electronics and the increased focus on schoolwork.   They were, however, in different places, and thus didn’t have a chance to fight, and had serious one-on-one focus.  Still, neither finished their work completely.

Day two (Friday) went less well.   The Captain called me at work twice to complain about having to do “so much work”.   Frustrated, I allowed them to stop where they were at 1pm or so, and said I would work with them later.

Friday night, The Admiral took them out for a board game / card game night at the library, which apparently went well until The Captain did not win a match and thought he was being ganged up on in the game by the other kids.  He called and asked me to pick him up, an hour before the end.   He was frustrated and angry, but it didn’t last too long. 

Saturday, both boys were very good in the morning, very cooperative and positive.  We had a cousin’s birthday party to attend, and they both were rather well behaved, save for one small moment of fighting. 

When we got home, instead of rushing home to use their 1/2 hour of electronics for the week (which I had actually upped to 1 hour because they had been pretty good), they played outside for a long time with the hose, spraying each, without fighting a bit. 

When it came time for electronics, they weren’t sure what to do with their time because the time was so short.  They used the computer a bit, and shared some time watching a show on Netflix.   They didn’t whine or complain much when the time was over.

Later, we had the grandparents over unexpectedly for dinner, so we all rushed to straighten the house, and then they had a great rest of the evening.   They also watched an episode of a documentary show about birds (David Attenborough – The Life of Birds) while the grown-ups were talking.

Bedtime was easy with the assistance of the melatonin, and instead it was the older brother who kept coming out of his room with this excuse or another.   We realized that because of The Captain’s fiery tantrums and overall stress inducement, we often overlook the mild bad behavior of his brother, because it is a welcome relief.

Sunday went almost as well.   The Captain woke up early and washed dishes and otherwise cleaned happily, without being asked to.   I can’t tell if he really did it to be nice, or if he was trying to get some measure of electronics back.   After his morning risperdone nap, he got stuck in the mindset of whining “There’s nothing to do!” etc. etc.

We managed to keep busy the rest of the day with other distractions, and more documentaries, and actually watched a movie with them in the evening.   The Captain did not want to go to bed, but did not put up much of a fight.

New Order

The Captain has been varying in mood and irritability.  We can definitely say he is better than he was before the risperdal, but he still has his moments, and quite a few of them.

On Tuesday, we discovered that he has been blackmailing his brother for an undetermined time (a while).   Apparently he would hold any slipped swearing or other indiscretions against him, promising to tell me about it unless his brother lied to me about the fact that they were both playing with a certain neighborhood kid they weren’t supposed to be around.

Both of them lost the privilege of independence – the ability to go to the park or convenience store, etc., by themselves.  For the blackmailing portion, I said we would talk to the psychiatrist since we had an appointment the next day anyway.

The Doctor prescribed a new regimen for discipline.   No more punishments!   Really, it was just a re-wording of discipline.  He said that they have the clothes on their back and three square meals a day, and everything else is a privilege they need to work for.   Also, no video games/TV/etc. during the week – only on Saturday (not Sunday), and only if they’ve earned enough points, and even then, only for a limited time.  He suggested a half hour.

Also, he said to lock up food treats, so we got a lock for the fridge and for one cabinet door.

The Captain took this surprisingly well.  Amazingly well.  I think it must be because it was coming from a higher authority source in his mind – The Doctor.  His brother made a scowly face, but accepted it well, too.

The part about points was a little vague, so we stayed up late last night trying to determine what gets points, and how many points they are worth, and how many points are needed for the electronics privileges on Saturday.

The Doctor also recommend a two-week reward and a four-week reward if the previous time was judged to be good… I’m not sure how that fits in with the point system exactly yet.

What The Doctor doesn’t realize, because it’s never come up, or we’ve avoided bringing it up, is that these boys are oversaturated in video games and computers and movies.  Up until this point, they’ve largely been unschooled, due to the problems we’ve had with The Captain trying to implement a true curriculum.

Today, they begin with a more regimented schedule, with Spectrum workbooks for math, science, writing, vocabulary, and geography, as well as multiplication and division flash cards, and U.S. state flash cards.   We also got a game that teaches about human anatomy.   This is not the ideal curriculum – this is the cheap curriculum to get them used to structure.

For fear of them literally not having anything to do, and rebelling from the whole system out of boredom, we also got them new lego sets and some playing cards.

Last night, The Captain spent the night at Grandma’s, who has been apprised of the situation, while The Explorer stayed home.   Each will have their chores and schoolwork separately, and perhaps that will help ease them into this transition.

Meanwhile, The Doctor added guanfacine back into The Captain’s regimen, starting a 1mg for the first week, followed by 2mg the next, 3mg the next, and finally 4mg.     Thus, he is now on 3mg of risperdal + 1mg of guanfacine, and 5mg of melatonin at night.

I’m at work, but look forward to hearing how their days went.

Weekend Review

A nice long weekend.   The Captain was mostly good, handling change / transitions / disruptions (not getting his way) well for the most part.   Sunday night he got the Melatonin about an hour before actual bedtime and for the first time in weeks, he went right to sleep without any tantrum or complaint.

Aha!  We had discovered the key.   Previously, we had given him the Melatonin about 20 minutes prior to bedtime (per the bottle’s instruction).   Perhaps he needed to be really tired before it would kick in so smoothly.

We tried this method again last night, but it failed.   It may have worked though, if he hadn’t received a call from Grandma last night, and wanted to spend the night at their house.  His tantrum last night was over not being able to go.   He blamed his brother because his brother didn’t want to go.

This morning, he woke up early again, before 5am, and quietly had breakfast, took a shower, and started being helpful, cleaning.  He’s a different person in the morning.

An Apology

At The Captain’s appointment last night with the psychiatrist, The Doctor told him that he needed to apologize to his brother about having attacked him with a piece of wood.

Inwardly, I rolled my eyes.  We have had this conversation with this boy.  It does not work.  He does not apologize, or if he does, it is never, ever heartfelt.

The Captain responded with obligatory answers and nods.

The Doctor said he needed to buy a card for his brother, and write his apology in it.  He said that would be a big deal and that we would all be very proud of him for doing it.  He told us to make it a HUGE deal, and celebrate the moment with cake.

Eyes still inwardly rolling, we left and stopped at the store on the way home for the card.   He picked out a blank card with cats on it, and wrote “I’m sorry for hitting you” on the inside, and drew a picture of a person crying a lot.

When we got home, he gave the card to his brother and watched him open it.   His brother smiled and The Captain wrapped his arms around his brother, without prompting, and said “I’m sorry” and “I love you.”

We were amazed.  And The Captain noted that the cake was indeed, not a lie.

Afterwards, we had cake, and he was really, actually, very proud of himself.

The Week in Review

Monday, May 24th – The Admiral said that The Captain had some issues today, mostly arguments over commands and transitions.  I witnessed a bit of the same when I got home.   The melatonin again knocked him out at bedtime.

Tuesday, May 25th – Again, still argumentative over things during the day.  Both boys skipped homeschool group.  The Captain knew he would not be able to handle himself there, and The Explorer feigned sickness to avoid it.   When I got home from work, The Captain was obviously heading into a mood, so we gave him an extra .5 mg of Risperdal.  The boys had avoided their chores, so I made them do them when I got home.   The Captain found new energy and mowed the back lawn and weedwacked in addition to normal chores.   Quiet time was good until it switched to Bed time, where The Captain threw a fit about going into his room (there’s nothing to do!) and kept coming out of his room, until eventually, the melatonin kicked in.

Wednesday, May 26th – The Captain woke early.  Had a semi-good day, with oppositional behavior to parental requests.   Met with his therapist, which went “Fine.”  Bedtime woes again, until he passed out.

Thursday, May 27th – Day behavior about the same.   Early wake ups all week.  Appointment with The Doctor in the evening.   Two developments… One:  he noted that aggression was gone, but oppositional behavior still existed.  He upped the dose from 2mg to 3mg.   Two:  he discussed apologizing to his brother, which I’ll cover in a separate post.

Friday, May 28th – Woke early again, in a good mood.  I am hopeful.

He who fights with monsters

“He who fights with monsters might take care lest he thereby become a monster. And if you gaze for long into an abyss, the abyss gazes also into you.”

– Friedrich Nietzsche, Beyond Good and Evil, Aphorism 146

Not the most optimistic quote, but it resonated with me.

New Research in Juvenile Bipolar

I’m reading about new research regarding childhood bipolar, which includes changing the way they categorize the disorder into a dimensional approach, because of the frequent overlap (comorbidity) of other disorders.

Other symptoms of juvenile bipolar disorder (all of which are true for The Captain except the nightmares):

• deflects blame
• suffers horrendous nightmares
• antagonizes siblings
• excessively craves sweets and carbohydrates
• functions in mission mode
• wets the bed
• sleeps hot
• takes excessive risks
• hoards food
• has many ideas at once
• interrupts or intrudes on others
• experiences periods of self-doubt and poor self-esteem

One of the phenotypes they’ve identified is the “Fear of Harm” phenotype (The Captain’s matches in bold and red).

Territorial Aggression

• is willful or refuses to be subordinated by others
• argues with adults
• defies or refuses to comply with rules
• is easily angered in response to limit setting
• is bossy towards others
• relentlessly pursues own needs and is demanding of others
• blames others for his/her mistakes
• has protracted, explosive temper tantrums
• displays aggressive behavior towards others
• has irritable mood states
• lies to avoid consequences of his/her actions
• is intolerant of delays
• has difficulty maintaining friendships

Attention / Executive Function

• has difficulty organizing tasks
• demonstrates inability to concentrate at school
• is easily distracted during repetitive chores and tasks
• attempts to avoid homework assignments
• has poor handwriting
• is easily distracted by external stimuli
• has difficulty estimating time
• able to focus intensely on subjects of interest and yet at times is easily distractible
• has auditory processing or short-term memory deficit
• has difficulty making transitions

Mania

• has periods of high, frenetic energy and motor activation
• has period of excessive and rapid speech
• has many ideas at once
• has elated or giddy, goofy, silly mood states
• is easily excitable
• interrupts or intrudes on others
• is hyperactive or easily excited in the PM
• displays abrupt, rapid mood swings
• fidgets with hands or feet
• is very intuitive and/or creative
• tells tall tales; embellishes or exaggerates
• has exaggerated ideas about self or abilities

Harm To Self Or Others

• Makes clear threats of violence to others or self
• Makes moderate threats of violence to others or self
• Has made clear threats of suicide
• Curses violently, uses foul language in anger
• Has destroyed property intentionally
• Is fascinated with gore, blood, or violent imagery

Self-Esteem

• feels easily criticized and/or rejected
• feels easily humiliated or shamed
• experiences periods of self doubt and poor self-esteem
• complains of being bored
• has periods of low energy and/or withdrawals or isolates self
• has decreased initiative

Sleep/Arousal

• has difficulty getting to sleep
• has difficulty settling at night
• sleeps fitfully or wakes in the middle of the night
• has difficulty rising in the AM

Sensory

• is extremely sensitive to the textures of clothes, labels, and tightness of fit or socks and shores
• exhibits extreme sensitivity to sound and noise
• complains of body temperature extremes or feeling hot despite neutral ambient temperature

Hypersexuality

• displays precocious sexual curiosity
• exhibits inappropriate sexual behaviors (openly touches self or others’ private parts)

PPSO

• wets bed
• has night terrors and/or nightmares
• hoards or avidly seeks to collect objects or foods
• has acknowledged experiencing auditory and/or visual hallucinations
• craves sweet tasting food
• has concerns with dirt, germs, or contamination

Anxiety

• displays excessive distress when separated from family
• exhibits excessive anxiety or worry

…  and what does that all mean?

The expectation is that, when we identify the causative genes for bipolar disorder, we will be able to point to a network of signaling pathways in the brain that regulate specific behaviors associated with the condition. Once researchers are able to isolate the genes involved and understand their functions, the development of more targeted treatments becomes a real possibility.

Bipolar Mission Mode

When I read in The Bipolar Child about “Mission Mode,” it really hit home.  The Captain at least once a day finds an unreasonable request that he must continually ask for every five minutes.

Mission Mode is the bipolar child’s intense need to do something, where no amount of reasoning or discussion can deter them.

Their sheer persistence is all-encompassing and they become very adept at blocking out any agenda but their own (which they are feeling very intently and very urgently)

…

They are inflexible–they perseverate or can’t move off a topic, they can’t anticipate that this kind of behavior will bring negative reactions from those under assault by their perseverative plans, and they have impulse control problems and cannot wait for something. (They may also be anxious that they will forget what it is they want; or they may be using this sudden gusto about a project or new idea to focus their thinking.) The new idea may be a stabilizing force that supplies an external structure because deep down inside they are afraid they are disappearing down the rabbit hole. They experience their need as an emergency situation, and so urgent that it is as if their very survival depends on their getting whatever it is they think they have to have. Any refusal on the parent’s part seems to make them feel unprotected and unloved.

From what I gather, once a child is stabilized with medication (which I am not sure yet if The Captain can be described as such), ignoring him and repeating your response, and using cognitive mediators is the solution to this.  (see links above)

ADHD Symptoms

And just for good measure, here are the symptoms of ADHD (all of which apply to The Captain, so I won’t bother bolding or coloring the text).

Inattention:

• difficulty paying attention to details and tendency to make careless mistakes in school or other activities; producing work that is often messy and careless
• easily distracted by irrelevant stimuli and frequently interrupting ongoing tasks to attend to trivial noises or events that are usually ignored by others
• inability to sustain attention on tasks or activities
• difficulty finishing schoolwork or paperwork or performing tasks that require concentration
• frequent shifts from one uncompleted activity to another
• procrastination
• disorganized work habits
• forgetfulness in daily activities (for example, missing appointments, forgetting to bring lunch)
• failure to complete tasks such as homework or chores
• frequent shifts in conversation, not listening to others, not keeping one’s mind on conversations, and not following details or rules of activities in social situations

Hyperactivity:

• fidgeting, squirming when seated
• getting up frequently to walk or run around
• running or climbing excessively when it’s inappropriate (in teens this may appear as restlessness)
• having difficulty playing quietly or engaging in quiet leisure activities
• being always on the go
• often talking excessively

Impulsivity:

• impatience
• difficulty delaying responses
• blurting out answers before questions have been completed
• difficulty awaiting one’s turn
• frequently interrupting or intruding on others to the point of causing problems in social or work settings
• initiating conversations at inappropriate times

Early Onset Bipolar Red Flag Symptoms

IN reviewing the “red flag symptoms” of bipolar in children, here’s how The Captain stacks up (ones that match are bolded and red):

Very Common Symptoms of Early-Onset Bipolar Disorder

• Separation anxiety
• Rages & explosive temper tantrums (lasting up to several hours)
• Marked irritability
• Oppositional behavior
• Frequent mood swings
• Distractibility
• Hyperactivity
• Impulsivity
• Restlessness/ fidgetiness
• Silliness, goofiness, giddiness
• Racing thoughts
• Aggressive behavior
• Grandiosity
• Carbohydrate cravings
• Risk-taking behaviors
• Depressed mood
• Lethargy
• Low self-esteem
• Difficulty getting up in the morning
• Social anxiety
• Oversensitivity to emotional or environmental triggers

Common Symptoms of Early-Onset Bipolar Disorder

• Bed-wetting (especially in boys)
• Night terrors
• Rapid or pressured speech
• Obsessional behavior
• Excessive daydreaming
• Compulsive behavior
• Motor & vocal tics
• Learning disabilities
• Poor short-term memory
• Lack of organization
• Fascination with gore or morbid topics
• Hypersexuality
• Manipulative behavior
• Bossiness
• Lying
• Suicidal thoughts
• Destruction of property
• Paranoia
• Hallucinations & delusions

Less Common Symptoms of Early-Onset Bipolar Disorder

• Migraine headaches
• Binging
• Self-mutilating behaviors
• Cruelty to animals