Definitely ASD, but could she also have bipolar disorder?

by Kim

Where to begin? I have four children, with multiple issues. My son, age 27, was diagnosed with ADHD in third grade. As an infant he received early intervention for sensory issues. He is extremely bright, but an underachiever. I believe he is bipolar. Why? His rages, lack of sleep, ideas, self medication with alcohol,and also a huge family history.

My great grandmother was institutionalized at age 45 for the rest of her life due to mental illness. My grandmother was in and out of hospitals her whole life, had ECT therapy many times throughout her life. My mother suffered severe postpartum depression and was hospitalized a few times. I don't know if she is bipolar - but she is "depressive" and stunted emotionally. At a recent family reunion I found out a great aunt committed suicide at 21, and that the majority of them were bipolar. There are quite a few artists, a famous musician, professors and even a movie director. There were also a few with histories of alcoholism.

I waited as a teenager for the family curse to hit me. I feel I have escaped, though lately I can say that I do feel somewhat depressed and will have to seek help for it, but I do have major life stressors that can explain my depression.

My first daughter is now 22, she was a hypo sensitive child, unlike her hypersensitive brother! At age 7 I had her tested, I thought she was "slow". Turns out she had ADD, and was also extremely bright. I just wasn't used to such a lethargic child after my first! She was a little "different and marched to her own beat" She started suffering from extreme social phobia during middle school. By high school, she was extremely depressed and tried to kill herself. Her depression was so profound, she was beginning to hear and see things that weren't there. After a lengthy hospital stay (where she learned the art of cutting) and needing 33 pills a day, my once sweet girl was now a zombie. She was diagnosed as bipolar, and also highly likely as having Asperger's. Other than not sleeping and a habit of shopping too much, I could not understand a diagnosis of bipolar. I was told that because of her reaction to fluoxetine and the profound depression, it was most likely bipolar. We ended up at McLeans for ECT therapy. We ended up not doing it, she was only 16 1/2! Fortunately after a long hard road and proper medication, she is doing much better and is attending college and is on the deans list!

My third child (now 21) was a whirlwind since birth. Four hours old, I went to the nursery to get her and I was greeted with "Oh, you're her mother. She hasn't stopped screaming since she got here." Four hours old and I was already terrified. She was the most miserable baby ever! Love her dearly, and she also was cute as a button, but if she was anyone's first child, she would have been their last! She had night terrors until she was 6ish. At age 7, we put our house on the market and during that time she developed trichotillomania and obsessive frightening thoughts due to the great stress she felt with our potential move. This is a child who could not ever accept any change. She had huge sensory issues surrounding clothing and noise. She also has ADHD. She also is in the superior range of IQ. She is somewhat of a loner, but she does okay. She is going to college part time (National Honor Society) , has pink hair, many tattoos & piercings and spends most of her spare time reading. She is fiercely independent and knows what she wants.

That brings me to the youngest of the bunch, my 12 year old daughter. I waited years to have this child (my 3rd was so much work I had to wait & regroup)! Right away, I knew she was different (she was the 2nd most miserable baby ever! Thank god she was cute too!). She preferred looking at light bulbs and not people. Like all my other children she started talking very early, except it ended up being echolalia. She didn't have any communicative skills at all, she couldn't even point. When you called her name, she seemed deaf. She was diagnosed as "classically autistic" at 2. She had alot of early intervention (I managed to get her in by 15 months). By the time she was 5 I had her neuropsych evaluation and the doctor told me that she was more probably Asperger's. She no longer twirled in circles or arm flapped, or lined things up. She was now an engaging little girl with an intense interest in animals and bugs (she also

has a superior range IQ).

Unfortunately, she had about 3 good years. By the time she hit 8 years old, her sensory issues started to get out of control. She is now pulling out her hair, biting herself, scratching herself and poking herself with sharp pencils out of frustration. She also has a long standing history of pica. I know the autism/asperger's is one problems. I just don't know if her phobias and intense reactions to being exposed to them is part of autism or could she be exhibiting signs of bipolar? The school LCSW, is concerned that she has a "thought disorder" and sometimes doesn't seem to be based in reality. With all these overlapping symptoms how can we tell just what it is?

In all fairness to my family, I will have to say my husbands family is not any better! They don't have bipolar issues the majority of them have OCD. Some have had severe depression, eating disorders, anxiety and a few of them cut in the past. Looking back now, I feel so bad to have passed all these things onto our children. Individually, we had enough history, together it is ridiculous!

Adding to my sadness over my youngest daughter, is the fact that I can't get the proper help. Her behavioral pediatrician & therapist aren't taking our concerns seriously. The school therapist sent a letter to the Dr. telling him about her self injurious behavior and all he did was up her prozac by 10 more mg. It did nothing. I have also tried to get her seen by new doctors, but a lot of them don't take insurance and I ran out of funds with my older daughter when she was hospitalized and I incurred HUGE costs associated with her care. I just can't do that anymore (ran out of equity). I can't find a therapist to help us with CBT. It shouldn't be this hard to get help, so hard that I am now writing all of this to you, in absolute desperation.

What is the next step, could it be bipolar in conjunction with ASD? What are the outcomes/expectations for children like this? When she was 5 the doctor told me "Don't worry, your daughter is so smart, her cognitive potential is huge". Now I feel with her regression, she will be unable to function in the world at all. If you know of any teaching hospitals doing studies on families with huge mental health histories, I would gratefully get in touch with them!

Thanks for listening,


Dear Kim

I don't know where to even begin in responding to this lengthy post. Children can have mood disorders overlapping other diagnoses. In children as you have come to know, these issues are very difficult to distinguish. It is also important to understand that there is much overlap in symptoms across the categories of diagnoses that we use in mental health. It seems to me that it is important to find out what is happening inside your little girl's head. Are those acts of self harm coming from someone telling her to hurt herself, sensory issues or something else?

When someone says a child has a thought disorder usually they are referring to a psychotic disorder and that could mean bipolar or schizophrenia. However, there is much controversy about this term and children and adults on the ASD spectrum have been shown to demonstrate similar patterns.

Pica is an interesting diagnosis that has been linked with mineral deficiencies, and there is a suggested relationship with schizophrenia and ocd. It may be important to get a full medical workup if you haven't already done so to determine if she may be deficient in any vitamins and minerals that are contributing to her issues.

I would suggest to you that you find a good mental health professional who understands mental health issues in children well ( a good grasp of all the diagnoses) and is not wedded to a particular diagnosis. Children have to be treated holistically and skillfully and although the quest for an accurate diagnosis can be fruitful, it also may distract from getting your child help from the cluster of symptoms she is having.

For example, she needs help with those self harm behaviors. Somehow that needs to be addressed.

I hope this makes sense and is helpful in some way to you.


Kristen McClure

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