Tuesday, November 16, 2010

Just Another Day & Another Rage

Yesterday, we continued to see problems. When I picked my son up at school I could tell we were going to have a rough day by the look on his face. It turns out that my son got in trouble for jumping off the top of the play structure during recess. As a consequence, he was told that he would lose all his morning recesses for the rest of the week.

As you can imagine, this just set his mood into a downward spiral. For the rest of the day I was constantly navigating his emotions, trying to keep him calm. I even had a problem with him running off in the store and being impulsive.

At the end of the day, when I was at a church gathering, my husband went to put the boys to bed when my son went into a violent rage. My husband noticed that he seemed to intensify much faster than the past and he was very physical towards my husband.

After the mania that occurred last week, we increased his Trileptal again, but I haven’t seen a positive change yet, like we’ve seen in previous increases. I think in my gut I know we may be headed towards an additional medication.

I hate the thought of that. Every medication comes with new side effects and new risks. But our doctors don’t have anything else to offer. Even our therapist told me that if it’s biological, therapy won’t help in the heat of a rage, only medication can.

The other thing I’m struggling with is the school’s consequence. I know my son should have a consequence for jumping off the play structure, but to have a punishment that will last for an entire week is unbearable. This will just continue the downward spiral of his mood. He needs a consequence that is immediate, then he has a fresh start. I also think that his behavior may be connected with his recent instability. It’s very unlike him to do risky things, when he’s stable he’s very cautious. So for him to make such a bold move at school, makes me wonder if his body was still having moments of mania. So to take away recess, a moment where he can get some healthy exercise, seems to be a move in the wrong direction.

* * *

So how does your school handle consequences with your child?


  1. That consequence seems VERY excessive. I could understand all recesses taken away for the day, but not the whole week. Maybe a phone call to the principal to arrange for some other punishment? So Sorry and give your son a hug from us!!

  2. Luckily, I don't know yet how school will handle anything like that.

    You are so calm with your son and that is so good. Keep up the good work!

    Last week Charlie's pdoc gave us some kind of "blow dart" as he called it to knock him out when he rages and is dangerous. I don't know what it is at the moment, but will look and get back to you about it. When it is biological, no talking will help, but maybe this will. We have not had to use it yet.

    Hang in there!

  3. http://www.webmd.com/drugs/drug-7681-Hydroxyzine+HCl+Oral.aspx?drugid=7681&drugname=Hydroxyzine+HCl+Oral

    Our pdoc said it would "knock him out".

  4. I don't know if your son has an IEP, but our shrink documented that using recess or gym as a consequence would be detrimental to my daughter's well being. It was put in her IEP, which makes it legally binding and gives the principal and teacher no wiggle room. Our PRN is a form of Risperidal that instantly melts under her tongue. Good Luck!

  5. I'm so sorry to hear about yet another rage. I agree that this consequence is too excessive, especially for a kid who suffers mood disorders. I think I would make an appointment with the principal and try to have the punishment changed to something that is more appropriate. Exercise is one of the BEST things for our kids - why not make him run laps at recess instead? Or write an apology letter detailing why it's wrong to jump off the play structure and keep his recess? I don't know how our school deals with this yet, but I would certainly go down and fight if I thought they handled it wrong.

    I know you are hesitant about adding the risperdal, but we have seen a vast reduction in rages since we started. I think we may need to increase another 1/2 pill, but I've been really happy with the results so far. Hang in there. We're all here for you!

  6. He needs an IEP and a BIP and then hope they follow it. We had good luck in elementary school with the schools being helpful. Middle school was a different story. I agree with the others that having a prn med for rages helps but remember rages happen for a reason - usually frustration, sadness etc. and the only way to really get rid of them is to address the root cause. I know very few bipolar kids that are in regular, mainstream classes and they get into the higher grades. Regular public school without quite a bit of support is tough for these kids.

  7. That definitely sounds like manic behavior to me, especially if he is not normally a risk taker. When my daughter is manic she was asking permission to do things that normally would terrify her (birds can fly mommy, why can't I, can I go sit on the roof??). Both Risperdal and Lamictal have made huge differences in the rages both in frequency and intensity. Your gut is probably right that a med change is in order. And no amount of therapy can help them when they are manic. They can try to apply the coping techniques that they know, but at some point in time, the chemicals just take over and there is nothing they can do to contain it. Our tdoc made that abundantly clear to us on one of our first visits with her. I said something about my daughter being good when she wants to be, and she quickly corrected me by saying that she was good when she COULD be. A big difference. I agree that you need an IEP and a BIP and specifically address the areas of appropriate consequences for misbehavior. Have you already alerted the school of his recent episodes? They need to be aware of his possible flight risk if he becomes severely manic and have a plan in place to contain him safely. I hope it gets better soon!

  8. Hey ladies... what is a BIP? My son is doing well at school and they tell me he doesn't need an IEP or a 504 yet, so we're holding off. I've been fortunate to have amazing teachers so far who've been very supportive of his diagnosis. He's also taking anger management classes through school. Do I need to do more?

  9. I was wondering the same, I've never heard of a BIP. My son has a 504 plan, is that enough? I guess I can have them come up with a better plan for consequences and add it to the plan for the future. Our therapist told us to not change the recesses since he already got the consequence, if we change it, it will make him think he's getting out of trouble. Whatever...

    Though I did talk to the teacher today and she gave my son the option of picking which recess he wanted to get "benched" on each day. That seemed to help him accept it better since he was given some control over it. In the future I want to avoid recesses being affected though. I also did mention that his behavior may be related to his illness and if he starts to talk back or runs off to alert me asap.

    Our day today was no better, my son had another rage today after school, the anger is coming on pretty strong. Much more than normal.

    Kelly-I like what you said about they are good when they can be. I know this to be true. What he can, therapy is a success and our discipline works, but when he’s unstable, nothing works.

    Meg-you touch on a topic my husband and I were just talking about. We don't know if he'll be able to stay in the regular education system, we may be looking for options in the future.

    Sarah-You'll have to fill us in on the new method once you try it.

    The Mom- Thanks for the hugs : )

  10. BIP is a Behavior Intervention Plan. It is typically part of an IEP and it spells out more specifically how certain behaviors are to be addressed within the school system. I am not very familiar with the 504 since my daughter has an IEP she did not need the 504. Does that specifically address behaviors?

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  12. I got sent home a lot, which meant I had to be with my step mom which just made everything worse. I'd also get detention or silent lunch, sometimes they'd send me outside in the hall and I'd wander around. The school I'm at now, they're "equipped" to deal with mood swings, "temper tantrums", "rages", and panic attacks.

  13. Hayden- I’m glad you have a better school. Can you share what type of school it is? You don't need to give names, I was just curious what type of school works best for kids with mood issues.

    Kelly- Our 504 plan just has a list of things that he should avoid, what types of teachers are best for him and things staff can do to help him thrive. It does not include how to discipline though.

  14. My son is blessed to be going to a school within our district that is for children with behavioral problems or mental illness (ADHD, Bipolar, and Autism) that cannot function in the main stream class room. My son is bipolar and has rages at school and he was getting suspended for his behavior and it was scaring the other children at school. So they sent him to this school which has small contained classrooms of about 5 students, 3 teachers for different subjects and numerous behavioral coaches to help with the kids. Plus there is always a psychologist on campus who is very involved with the care of the student. When I take him there I never have to worry about a phone call home to come pick him up because they are capable of handling him. They know how to restrain if he is becoming dangerous or trying to leave campus, and they know how to reward him when he does just that little small positive step that they would not notice at a reg. school. We are lucky to have a great IEP that spells everything out in black and white and makes things so much easier. The only thing my son does not like about the school is it is hard to make friends because there is not a lot of kids, but he can still go to the old school for school events like dances and games, so he still gets to see all of his old friends and feel a part of the school still. Don’t get me wrong it has not corrected his behavior, most of his days are still bad ones, but these are the people who are going to be able to help him. He is starting to talk to his teaches and he is learning to take self timeouts, and he has become much less aggressive. Check with you school to see if anything like this is offered in your district, because it has been a life saver. At the old school after taking him to school for the day I would be on pins and needles all day long worrying about what was going on and when was I going to get the call, which did come every day. Now I take him to school and I know there will be problems, but I know they are capable of taking care of it and I take it as a welcomed break Mon-Friday and we as mother of bipolar children really really need our breaks!!! My son also take Risperdal but not prn, he takes 2.5mg in four divided doses through the day along with Depakote and Lithium, which has been the best med combo we have been on so far. Rages are much calmer, not nearly the amount of damage he used to do. Before he was punching holes in the wall and breaking whatever he could, now he throws some soft things and just bangs on the walls to be annoying. Sometimes we even feel like we have our old boy back , the new one always creeps back, but it is easier to remember why you do this when you get that sweet little boy back for a little bit!!! Thanks for your blog I love to come on and see how other moms are handling their special children!! Sorry to go on for so long…

  15. Thanks Lisa for sharing, I welcome long posts, the more info, the more we learn! Your school sounds very interesting, I haven't heard of something like this in our area, only charter schools. I may need to research it if needed in the future. Luckily, he hasn't had a rage at school, but he’s having a hard time fitting in with the other kids at times, lately he's been picked on. Our Principal is taking the step of monitoring this now. He's giving a journal to my son so he can write down any incidents that occur, with the kid's name and what happened. Then during the week he'll check on it to see what's going on. I think he's trying to find out if a certain child is instigating it.

    In the future, middles school and high school I'm sure won't be able to be so hands on with issues, so that’s when we may need to look into these other options.

    Also, if rages start at school, we may need a new solution sooner.

  16. Caroline used to regularly jump off the top of our jungle gym and did similar things at school. She also jumped out her second story window a couple of times. She never got hurt. Very manic behavior. I am so sorry he is not well right now and raging. This is the worst disorder because it robs our kids of their childhood.

  17. Megan-Wow! That must have been scary to have her jump out the bedroom window. You're right about this disorder robbing their childhood, it also robs some of the joys in parenting.

  18. Mama Bear- It's just a school that helps kid with learning disabilities, emotional problems and stuff like that.

  19. Mama Bear - you might want to start looking into what kinds of schools your district offers now so you will be prepared as puberty comes on (which typically further complicates medicating, etc) In our case, we don't many options and what we do have is not good so we homeschool. However, in some parts of the country there are great options so it really just depends where you live.
    Also, the BIP is a behavior plan that is part of the IEP (I wrote a post on BIPs a month or so back). Like an IEP though it is only good if the school follows it and like everything else, some schools are great at this and some are terrible.

  20. Meg- That's a good idea to look into schools now. Boy, the whole research aspect of raising a child with a disorder is like a part time job, I have so much to look into! I think I need staff!