Diagnosis: A little of everything

I'm sitting here with a copy of the DSM on my shelf wanting to rip my hair out. For those of you not familiar with the DSM, it's a book used to diagnose mental illness, etc. It has codes for all accepted diagnoses and has a list of accepted criteria for each diagnosis. When someone says they have a diagnosis, they mean that they meet all the criteria for that diagnosis listed in the DSM. I've heard talk that the next edition may contain both childhood onset bipolar and sensory processing disorder as new and accepted diagnoses. Here's the full current edition for anyone curious DSM Online

The frustrating thing about childhood bipolar is that because it's new, people are still agreeing on what it looks like. On top of that, it seems to have a very high rate of comorbidity (other diagnoses being present along with it). This muddies the waters in terms of what is generally seen in bipolar, and what is part of diagnoses often occurring along with bipolar. The childhood version doesn't seem to have nice clean cycles as are often seen in adults, and children often express depression through anger and irritability. As if that weren't enough, environmental stressors can make any child extremely moody and defiant as well. In short, it's a nightmare to try to diagnose.

I've hard many other parents echo this, and it's my constant lament: Any of the things Pajama Monster does could be seen as the far extreme of normal naughty behavior if it were the only incident. The thing is, it's not just one incident. It's hundreds, happening very frequently and seemingly without warning. Other kids show signs that they're getting frustrated and then lose control, but my little boy suddenly just smiles as though possessed and proceeds to destroy things.

I've tried so many different diagnoses on for size. He has a sampler platter of so many, but doesn't meet the full criteria for most. He's extremely active at times, but not as much as a child with severe ADHD, and he seems gleeful, not oblivious to the results of his actions. He is rigid in his thinking, but with social skills that clearly show he's not autistic. He meets criteria for ODD (Oppositional Defiant Disorder) but that's just a name for symptoms, not a cause. A diagnosis of ODD will get you insurance coverage in most cases, but is otherwise useless. It's the mental health equivalent of going to a doctor because your throat hurts and being given a diagnosis of "sore throat." You already knew your throat was sore. What you want to know is WHY and how to TREAT it. Before I launch into a list of what's going on with Pajama Monster, let me just give my gut feeling on bipolar childhood symptoms: If it looks like ODD, anxiety, sensory problems, ADHD, and a few autistic features just for flavor, you may want to consider evaluating for bipolar. It doesn't mean that your child doesn't have bipolar AND one or more of those other diagnoses, but it may help in gaining a clearer picture of what's going on.

So, that's my rant, and here's the giant pile of puzzle pieces I'm trying to put together over here.

Anxiety?: He seems to go "Deer in the headlights" when overstimulated or confused.

Autistic features?: He has trouble engaging in structured creative play, such as playing kitchen. He gets locked on certain ideas and can't readily change. He sits and draws patterns for long periods of time and doesn't like things being out of order.

Sensory?: He becomes frightened when upside down and will get stuck on play equipment unless he's done the exact motor activity several times. The school OT suspects poor motor planning. He runs into things and falls frequently and has trouble mirroring actions that are demonstrated for him, such as a jumping jack.

Mood disorder and etc?: Tantrums over seemingly trivial things, extreme defiance and need to control, destruction of property including his own favorite toys.