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TOPIC TITLE: Student w/ BP
Created On 6/8/05 9:23 PM
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g
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6/8/05 9:23 PM
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Hi,
I would like to ask for some input/ advice from all of you on this forum. I teach a self-contained, special ed. class. One of my students seems to have all the characteristics of bipolar disorder, but has not yet been officially diagnosed as such. His initial diagnosis of ADHD led to meds, but there was absolutely no improvement in his behavior, not so much due to improper meds/ dosing, etc, but due to misdiagnosis. His psychiatrist does not want to put him on an anti-depressant, because of all the news hype about kids becoming suicidal when on anti-depressants. However, things are very difficult for him/ me as his teacher. He has very volatile mood swings, from severely depressed/ angry/ totally not able to cope w/ anything, like not having a pencil; rages, cries, rips up his work, very low frustration tolerance, etc. to being very giggly, hyperactive, giddy and not being able to "settle" down. This swings back and forth, triggered for no apparent reason.

My question is, w/o meds, what can I do for him? We've set up a behavior mod plan for him, which is effective do a degree, and he has a crisis management para, who is wonderful w/ him, but this is more of a "bandaid" solution.

Any suggestions?
Thanks.
 
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ernie55B
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6/9/05 11:32 AM
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Hello G!

As a father of a daughter with BPD who had many difficulties in all types of schools, I think the only solution is to get the proper diagnosis and get the student on the proper meds. ASAP. Behavioral techniques are good only up to a point as you said. But the proper meds. and DOSAGES are crucial if the student is to succeed.

Good Luck and good Yom Tov to you!
Ernie
 
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Torsalicious613
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6/9/05 3:04 PM
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i regret to say this, cause i hate the stuff, but medication is very important. i know, i know, but it works. it's really the only thing that worked for me. as my mom says, we're all a bunch of walking beakers. oh yeah, and research, and find a good doc. these medications are heavy stuff and shouldn't be treated lightly. as ernie says, dosage is very important too. i am not a doctor, but in my case and in most people's cases who i've talked to who are also bipolar like me, you are usually started on higher doses and are gradually brought down over time. i don't know if this specific method will work for you, but it has worked for me. good luck, and hang in there. things will get better. hold on. you'll see.

torsalicious613


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what the hecka is a signiature?
 
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Dr. Lynn, Psy.D.
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6/9/05 11:43 PM
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G-
Perhaps the child can be properly evaluated by an outside agency? This may change the diagnosis and make the psychiatrist more confident about medicating appropriately. Where are the parents in this picture? Maybe a different psychiatrist should be used- is the shrink affiliated with the school or on the outside?
a lynn
 
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g
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6/15/05 8:09 PM
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Thanks for your replies. The parent of this student is relatively cooperative, and does take some initiatives in helping the child. However, she has a slightly skewed perspective on how severely this is affecting her child. She doesn't see all the issues we see w/ him at school. I feel this is partly because she is a parent, and therefore automatically loses some of the objectivity, and does not see his behavior as compared to typically developing peers, or even peers with special needs (he is the oldest, and has one infant sibling); also, in part because what is "acceptable" behavior at home, is usually not acceptable in school. For example, if a child throws a tantrum at home while doing H.W., this may not be the "norm," but many parents may attribute this behavior to s/t the child does at HOME. If a child throws a tantrum at school, however, this is definitely NOT acceptable. Also, some behaviors can be in some way dealt with one on one, at home, but when that child is one of twelve students in school, this kind of behavior is certain to make waves.
We try very hard to ignore inappropriate behavior, only reinforcing the positive behavior, letting him know that when he can ask for help in an appropriate manner (and we spell out what that is), we can help him. This has been quite effective for most of the time. However, he still does have those initial "I can't cope!" episodes that really do disrupt the classroom flow.
Just to re-ask a question I touched on in my first post, as a general question, are the medications that may be prescribed to treat bipolar disorder anti-depressants? Because this kind of medication seemed to be a poor choice for this student, according to his p-doc, who as far as I know is not affiliated w/ the Dept. of Ed. Would a psychiatric eval. be in place for this child?
This has been quite frustrating to me, because I have been saying for most of this year, that this setting that he is currently in, is not appropriate for his needs. He appears to require a more therapeutic setting. However, because I am only his TEACHER (and why would you listen to a teacher, who only deals with him for the whole day?! --Sorry, I am being sarcastic), the school psychologist did not give my concerns the due consideration.
Sorry this has been a bit lengthy, I was just hoping to get a little more info. from you before I speak to the mother again.
Thanks so much for your feedback again. --g
 
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ernie55B
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6/16/05 2:24 PM
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Hello G!

It must be really frustrating for you when the school psychologist is not hearing what you are describing. In your first post, the situation sounds very much like a child who has BPD.
Anti-depressants are not a good choice, we found out the hard way, as some children become manic when put on them. (It was an awful scene when the police were called because my daughter was out of control). The psychiatrist who put her on the anti-depressant neglected to warn us that this may happen.
She was ultimately put on Lithium which is one of the most commonly used drugs for BPD. It is usually helpful in getting the patient's mood stabilized and keeping it somewhere in the middle of the spectrum.
It sounds like this child really needs to be evaluated by a good child psychiatrist.
Good luck trying to get this message across to this mother.

Ernie
 
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g
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6/16/05 2:45 PM
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Ernie,
Thanks for your reply. While I am not allowed to even suggest a diagnosis re: a student, when speaking to the p-doc I certainly can describe those behaviors clearly enough so they get the picture; I can also mention the lithium if they try to dismiss any meds b/c of the possible suicidal side effect. Any known side effects to lithium?

Thanks,
g
 
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ernie55B
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6/16/05 3:44 PM
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The most common are nausea, diarrhea, trembling of the hands, frequent urination, but keep in mind that EVERY drug has many possible side effects and most people do fine on them.
My daughter B'H does ok on it as well.
The very important thing to remember is that the child will have to be closely monitered by the MD to keep the amount of Lithium in the blood at therapeutic levels.
There are other drugs however, which require less monitering. Again, the child needs to see a competent child psychiatrist.
Try to stress to the mother how important it is to address this at an early age rather than later. The child will feel much better about himself if he can better control his behavior.
 
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Dr. Lynn, Psy.D.
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6/22/05 12:45 AM
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Ernie is right on two counts; first, that the child has to see a competant child psychiatrist, and second, that it is probably more appropriate for the child to be on a "mood stabilizer", such as Lithium. The first step is to see a child psychiatrist, so that a correct diagnosis can be made and the ball can start rolling in terms of helpful interventions. I would also keep a detailed record of the child's outbursts- duration, patterns, behaviors, and the interventions made by school administration when notified by you.
a lynn
 
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g
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6/22/05 1:28 AM
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Dr. Lynn,
Thanks. Interestingly, I have heard positive feedback about lithium from someone else too, and I really appreciate everyone's help in defining a course of action I can take to help this student get help for the root of the issue. I will keep you posted! Thanks again, --g
 
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Torsalicious613
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8/18/05 9:17 PM
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yeah, i'm sorry to say it too, but lithium works, with many unfortunate side effects! i should know, i've been on it for nine years. but it works, no doubt about that! good luck, g. best wishes.

tors


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