abandon hope all ye who enter here? - or, strap on your seatbelt. It's gonna be a bumpy ride.
After last week's revelations, I did some digging into childhood mood disorders to bring the Kinglet's picture into better focus.
When the doctor spoke to me of "mood disorder", I thought in terms of my own - a cyclic depressive disorder. I've seen the Kinglet fall into slumps, wish he wasn't alive, crawl under cushions and refuse to come out. I remembered what I'd learned in school about childhood depression looking more like anger, so that's what I assumed.
But having done a little more research I realize that even though depression in children doesn't look quite like what it does in adults, it still looks pretty much like depression. Which is to say a child that is categorically depressed spends most of their time in a depressed state, whatever that looks like...
What I found is that the Kinglet more closely matches the description of the bipolar child. The menu includes periods of depression, but higher up the list are things like:
# 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
and so son.
The thing is, a bipolar disorder also requires the grandiosity, inflated self-esteem, etc that characterizes mania, and because I've never seen this in the Kinglet I never thought bipolar disorder applied.
But after reading some materials I called the hospital doctor back and asked her to clarify.
I didn't catch what she called it, but what we're looking at is a... extreme variability and intensity in mood that might develop into a polar disorder someday, or might not. A... pre-polar disorder? Like... a pre-cancerous condition... not cancer, but still dangerous.
I asked the doctor - statistically, how many of children who are described in this way go on to a bipolar diagnosis? She said 1 out of 3. She put a positive spin on it - that's 2 out of 3 who don't. But I guess it depends on how you look at it - a 1 in 3 chance that your child will be bipolar is a lot more likely than the general population. And I didn't think to ask how many of the 2 out of 3 who aren't bipolar are otherwise unipolar/dysthymic/etc.
I asked what kind of medications is used to treat kids with this description. She said while they wouldn't use stimulants, there is some crossover to the kind of meds they use for ADHD. They might also use mood stablizers, moving up the spectrum towards lithium-class drugs if the lighter stuff doesn't do the trick.
Not that I'm considering any of that. Not at this stage. No matter how the diagnosis swirls and changes, we still feel he's simply too young for drugs. We want to see how and whether he matures.
If he thinks he can fly off of the roof when he's eight, then we'll reconsider. But not now.
Anyway, things change and they don't. We've been talking to the Kinglet all along about mood, trying to help him recognize and articulate his feelings, to understand that he isn't a bad person just because he gets mad, but at the same time he's responsible for the choices he makes when he's mad. I suspect there's going to be a lot more of that kind of discussion - like the one about how we feel isn't always how things ARE. That moods can be something that happen to us, make us see the world in certain ways, but like storms, they always pass, and the world that is real is still there like it was. Moods can be wondrous and magic - or dangerous. With a mood disorder, you have to learn to navigate them.
Hmm. Makes us sound like storm-chasers, don't it.
I can dig that. I always did get a trill from thunderstorms.
When the doctor spoke to me of "mood disorder", I thought in terms of my own - a cyclic depressive disorder. I've seen the Kinglet fall into slumps, wish he wasn't alive, crawl under cushions and refuse to come out. I remembered what I'd learned in school about childhood depression looking more like anger, so that's what I assumed.
But having done a little more research I realize that even though depression in children doesn't look quite like what it does in adults, it still looks pretty much like depression. Which is to say a child that is categorically depressed spends most of their time in a depressed state, whatever that looks like...
What I found is that the Kinglet more closely matches the description of the bipolar child. The menu includes periods of depression, but higher up the list are things like:
# 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
and so son.
The thing is, a bipolar disorder also requires the grandiosity, inflated self-esteem, etc that characterizes mania, and because I've never seen this in the Kinglet I never thought bipolar disorder applied.
But after reading some materials I called the hospital doctor back and asked her to clarify.
I didn't catch what she called it, but what we're looking at is a... extreme variability and intensity in mood that might develop into a polar disorder someday, or might not. A... pre-polar disorder? Like... a pre-cancerous condition... not cancer, but still dangerous.
I asked the doctor - statistically, how many of children who are described in this way go on to a bipolar diagnosis? She said 1 out of 3. She put a positive spin on it - that's 2 out of 3 who don't. But I guess it depends on how you look at it - a 1 in 3 chance that your child will be bipolar is a lot more likely than the general population. And I didn't think to ask how many of the 2 out of 3 who aren't bipolar are otherwise unipolar/dysthymic/etc.
I asked what kind of medications is used to treat kids with this description. She said while they wouldn't use stimulants, there is some crossover to the kind of meds they use for ADHD. They might also use mood stablizers, moving up the spectrum towards lithium-class drugs if the lighter stuff doesn't do the trick.
Not that I'm considering any of that. Not at this stage. No matter how the diagnosis swirls and changes, we still feel he's simply too young for drugs. We want to see how and whether he matures.
If he thinks he can fly off of the roof when he's eight, then we'll reconsider. But not now.
Anyway, things change and they don't. We've been talking to the Kinglet all along about mood, trying to help him recognize and articulate his feelings, to understand that he isn't a bad person just because he gets mad, but at the same time he's responsible for the choices he makes when he's mad. I suspect there's going to be a lot more of that kind of discussion - like the one about how we feel isn't always how things ARE. That moods can be something that happen to us, make us see the world in certain ways, but like storms, they always pass, and the world that is real is still there like it was. Moods can be wondrous and magic - or dangerous. With a mood disorder, you have to learn to navigate them.
Hmm. Makes us sound like storm-chasers, don't it.
I can dig that. I always did get a trill from thunderstorms.