Gifted Issues Discussion homepage Forums Twice Exceptional Mood disorder?

Hi, I was wondering if anyone here is familiar with what a mood disorder might look like in a young child? My DS is already diagnosed with ADHD, TS, and ASD, as well as being gifted (I guess hg would be the right label... hard to be sure these days?)

Ever since DS was young he was variable in his behavior. I used to say I thought he had cyclic adhd or asd, because sometimes he would seem to come out of it and be totally normal. Now that he is older and medicated for adhd, it's more the opposite. He generally seems pretty normal, but will slowly fall into about 2 week long episodes of miserable behavior that are only partially controlled by adhd meds. Before he gets his meds in the am and after they wear off in the pm he is unbearable during these episodes.

This time he started getting more negative and irritable about 3 weeks ago or so, but was still functioning generally OK. More yelling and oppositional behavior, but I thought maybe we were going to avoid the full descent. Then last week it started. After great reports from school for over 2 months I started getting phone calls. I had to pick him up early one day. Another day he hit a little girl in the face for cutting in line.

At home he has been a terror. He screams and cries about everything, throws tantrums/items when upset, hits, flips out if he loses a game, etc. The only time he seems happy is when he is annoying us mercilessly while giggling like a maniac. When given a consequence he goes into full blown crazy tantrum mode, throwing anything he can get his hands on, often at us.

This is not normal for my DS. He is generally a loving child who is eager to help out his mommy and who loves to do nice things for me/surprise me with little gifts. He's usually happy and has a great sense of humor, he loves to make up jokes and share them with us. He does have his issues normally, especially when not medicated, but he would never harm me when he's not in one of these moods. He is usually a bit of a sore loser, but he's likely to just say (in an upset voice), "OK, you win, I'm never playing this game again," and maybe have a little cry. When reminded that his behavior doesn't meet expectations he will put on a little smile and say good game sweetly and help me clean up. So, it's like the same strong emotions are always there, he still has tantrums and cries about things that other kids take in stride, but this full blown crazy irritable behavior, aggression, and just plain meanness that crops up randomly and lasts about 2 weeks each time is very concerning.

I know it seems like I should be asking a professional, but believe me I have. They either say it's part of asd, blame me, or try to convince me to put him on an antipsychotic. No one is willing to discuss a mood disorder in an 8 year old with a diagnosis of ASD. I also have been trying to get him into CBT for years, but every provider says he is too young to benefit. They will not make exceptions due to his high intelligence and overall great insight (when he stops to reflect, not in the moment!)

Even the school is amazed at how great he is doing at processing after the fact and the insightful things he says. They introduced "criss crossing" to him recently, which is an empathy/walk in the other person's shoes sort of idea and he has latched onto it, constantly telling me when he's doing it, when I'm doing it, and when he thinks someone should be doing it. He started crying the other day randomly and I asked him what was wrong and he said he accidentally criss crossed into his 1 on 1 he has at school when he said something mean to her earlier that day and he was crying because he was feeling how she must have felt. Then he ran upstairs to get materials to write her an apology letter. I'm pretty sure he could benefit just fine from CBT.

DS also seems to have some phobias. He is afraid of the dark to an usual degree and it terrified of bugs to the point where I can no longer get him to go outside much at all. If he sees a bug he runs right back in. He does not appear to have a lot of anxiety otherwise. He doesn't like to be alone at all, which I guess could be anxiety. He also is hesitant to try new things, but usually likes them when he does. He often says to me that he is worried about trying something, but that there's a good chance he will like it because I usually pick good things for him and he trusts me. But he still seems nervous and negative about the new thing until we get started. And then after he tells me how silly he is for doing it again, thinking he won't like something just because it's new and ending up loving it. He also does not cope well with stress at all. He is not generally a worrier, or if he is, he doesn't express feeling worried.

So, if anyone has any experience with mood disorders, does this sound like one? I know depression can look very different in young children and that irritability is a big thing to look out for, but it's also a symptom of just about everything for kids his age! The docs put him on prozac when he was 4 to treat suspected anxiety, but after a few months it made him totally crazy and manic and I took him off of it. It always seemed to me that all of his mood symptoms got much worse after the prozac, so I feel guilty about giving it to him, like I ruined his emotional brain somehow... but maybe he would have had that crazy episode even without it? He never even got up to the therapeutic dose because I saw enough improvement where we were at to want to stop there. He had been kicked out of 2 schools that year and we were looking at number 3, which is the only reason I relented and tried the medication for my little 4 year old. It's so hard to know what to do when your kid is failing at life and all the pressure is on you as the parent to do something about it A year later at 5 we tried tenex to help with the adhd and tics, but it had the opposite effect, it made him so unhappy and miserable and not himself that we had to take him off of it. It also affected his ability to think. He could no longer do complex calculations in his head and seemed to lose interest in the more cerebral activities that he had up until that point really enjoyed. When I brought up the obvious brain fog to the docs they said it was great, he was more like a normal kid!

Up until this past week DS has been doing great. He just had a birthday and really enjoyed his party. His school is doing a wonderful job with him. They use the 1 on 1 to give him his differentiated curriculum as well as to be there in case he needs behavioral help. He is actually learning there and filling in some gaps in math. He loves school! They have him doing fifth grade reading and math, but he's still in class with 2nd graders. He even gets gifted pull out, which doesn't normally start until 3rd grade. I didn't even have to ask for any of this! He's even doing all of his own writing now. Turns out having someone scribe for him helped him gain confidence to take over and do it for himself. His teacher says he is now the top writer in the class and does amazing work for a 2nd grader. This is great because writing had been such an area of concern for so long! He doesn't have any friends at school, but he has good friends outside of school. Some friends are from his old gifted school and some are the kids of my friends, all are above average intelligence to highly gifted and I think that helps DS to get along with them. He often tell me that he knows that the kids at public school don't have any interest in playing the way he plays, but that it's OK because he would rather play his games by himself than play games he doesn't like with the other kids. His bestie loves the game they play, which is just an ongoing imaginary story in some crazy made up science based fantasy land. DS also loves to play board games and card games, but usually he plays with adults as he likes games designed for older players that have rules too complex to learn in one kid sized gaming session. He plays different things with different friends, so he doesn't just play the same thing all the time. He tends to do best with 1 or 2 kids at a time and really enjoys his time with his friends!

He was doing so great! But this thing, whatever it is, is still with us and causing serious problems at school right now. Any ideas/insight would be greatly appreciated!

I have nothing solid to offer. I am dismayed that there has not been a professional willing to begin CBT with an 8-year old. You've probably consulted the gifted professionals on Hoagie's list?

It sounds like he has friends (outside of school), and that the school is a good "fit" in many ways. You've probably been through lists of known triggers for changes in behavior, such as:
- changes at school?
- academic difficulty (ranging form bored, to lack of support, even a sense of unwanted competition)?
- social problems in learning environment?
- friend move away, or ill and out of school?
- new teacher?
- new seat in the classroom? Sometimes a well-behaved child is moved to break up chronic misbehavers.
- any possible exposure to sexual conduct or contact?
- illness/death of a grandparent or other member of support system?
- changes at home such as new sibling, separation/divorce, parental job change, tight budget?
- changes in what foods are offered and eaten?
- HALT (Hungry, Angry, Lonely, Tired), as mentioned in this SENG article?

Wishing you all the best.

I'm sorry that he's having so much trouble. My eldest (genetically female, identifies as male), also on the spectrum, started acting similarly right around puberty, and has made a lot of progress on a combination of Prozac and Seroquel - but if you don't want to start meds, that won't help you much. You might look for self-guided CBT workbooks aimed at teens, and then work through them with him yourself.

Good luck.

First of all, good for you and for him that he has seen so much growth all around!

With regard to mood disorders--it's not impossible to have a mood disorder at this age, although I would also approach mood stabilizers and any psychotropics with caution, especially where there are multiple diagnoses. I will say though, that CBT is absolutely a reasonable treatment option for young children, whether or not they are clinically depressed or anxious. For example, this highly-regarded teaching hospital has a whole clinic for CBT in children:
http://www.massgeneral.org/psychiatry/services/treatmentprograms.aspx?id=1982

I have not personally used these tools, but know others who have had good experiences with them. If you can't find a professional willing to work with your child (which would, of course, be optimal), another possibility is to take some sessions of CBT yourself, and/or try using these workbooks with your child:
https://www.amazon.com/CBT-Toolbox-Children-Adolescents-Worksheets/dp/1683730755/
https://www.amazon.com/Think-Good-Cognitive-Behaviour-Workbook/dp/0470842903/

Saturn, I am so sorry to hear about the challenges your lovely young guy is going through. You are absolutely right to take the possibility of mood disorders seriously; eight, unfortunately, is not at all too young.

However, lots of providers out there still think of mental health as an adult problem, despite an abundance of research that most major issues start in youth or adolescence. So your challenge is to find a provider who takes you seriously, AND knows what they are doing with an 8 YO mixing in gifted and ASD. Unfortunately, I only know the Canadian end of the scene. My general suggestion is to start asking for names through research centres, where they'd be more familiar with more complex situations. I started with the NIH National Institute for Mental Health, and came up with a couple of #s:

Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357). SAMHSA also has a Behavioral Health Treatment Locator at https://findtreatment.samhsa.gov

https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

National Institute of Mental Health Information Resource Centre, 866-615-6464
Also has an online chat; scroll to very bottom of the NIMH link above

Also, I recommend talking to the National Alliance on Mental Illness, 1-800-950-NAMI (6264) or info@nami.org
https://www.nami.org/Find-Support/NAMI-HelpLine

Trust yourself, and keep calling until you find somebody who *listens*. Sending huge hugs.

I agree with what everyone else has mentioned that 8-years old is NOT too young for CBT at all. Here is a link to a free CBT for depression workbook online: http://s3-euw1-ap-pe-ws4-cws-docume...om/9780415399784/Verduyn_depression.pdf. There is also an app for trauma focused CBT game called Triangle of Life. While it is trauma focused, it would still give the basics of CBT.
I think the ASD diagnosis is what is likely complicating finding the root cause. If it weren't for that, I would say the symptoms do sound similar to bipolar due to the cycling (though the consistent cycling is unusual for kids, it's usually more sporatic in kiddo's), and the response to an SSRI (can be activating for those with a cyclical mood disorder). I would wonder how he would respond to a mood stabilizer. It might be helpful to also track his sleep patterns. There are also many apps for tracking symptoms of mood disorders, which may be helpful. For the ASD, applied behavior analysis (ABA) can be very helpful to regulate behaviors. But it might not be nearly as effective if there is an underlying, untreated mood disorder.
Good luck! Keep trying to find a clinician who will listen and work with you guys.

I can only speak to the challenges I have had with my DS 9 who has ASD. DS9 seems to have symptoms of a mood disorder but his counselor told us as well it was part of his ASD. His counselor explained when he sees a list of diagnoses in a child it is usually ASD. I am not really sure. However, I definitely agree with the others that CBT can be used for a young child as it has helped my DS. Second year in counseling and he has made a lot progress. He has conquered a number of fears, shut downs greatly reduced and mood has over all improved (he has always been moody but having less swings). There were many sessions he was not able to attend/participate fully because of his social issues/anxiety. We were still able to discuss issues to focus on with the counselor and use CBT skills to help him at home and school. Even when we did not think he was listening or picking up the skills he was! The counselor was very supportive and knew ds was capable even when he did not verbally respond in session. When selecting a therapist we went with one that specializes in working with children who had anxiety, depression and ASD. Good luck! I know it can be difficult to find a provider that is supportive and listens to your needs. We had to go through a few before finding a good one.

Has your pediatrician screened out any possible medical issue? There are organic conditions that can cause behavioral problems in kids, and my perception is that the psych professionals tend to "stay in their own lane" and not investigate whether the behavior/mood issue could have an underlying medical cause.

Our story is VERY similar to yours (sweet kid with crazy-disrupted behavior). Turns out that DD12 had severe celiac disease, probably since toddlerhood. Getting that diagnosis and addressing related nutritional deficiencies has been a game-changer. She still has issues but it's a LOT better. Happy to share details / answer questions by PM if that would be helpful.

FWIW, we consulted about a dozen counselors, therapists, psychiatrists, developmental pediatricians, OTs, etc. about complaints of anxiety, irritability, sleep issues, stomach aches, head aches, mood swings, increasingly disregulated behavior, aggression, epic meltdowns, depression, suicidal ideation ....; pretty uniformly, they diagnosed an anxiety disorder/depression and recommended medication, therapy, etc.
Finally, a CBT therapist we brought her to for her anxiety said she'd seen her kind of sky-high anxiety only a few times before, and in a couple of cases the kid had been celiac so maybe we should screen for it. We did and were shocked by the result (off the charts positive) as DD isn't the picture of a "classic" celiac kid - she's always been tall, ahead on milestones, not skinny, etc.

To be clear, this is not to say that your son's behavior is attributable to celiac - but please make sure that you push your pediatrician to screen for that, thyroid, etc. (anything that can affect behavior in kids), and even if celiac is ruled out, consider doing an elimination diet to see if there's an underlying food intolerance.

Good luck - it's really hard. Your son is lucky to have you as a parent.

Thank you all so much for the ideas/advice. I will look into everything mentioned and see what I can do for DS. He's been a little better since my last post, so hopefully he is coming out of it. I kept him home from school yesterday, but I sent him in today. He had an overall poor day, but he did not have any aggression, which I'll take at this point!

Now that he is 8 he might be old enough for CBT, I last checked over the summer when he was 7. I'll have to call around again. I do think part of the problem is the ASD diagnosis. People make a lot of assumptions about a kid on the spectrum (and as I've said in the past, I don't think I'll ever be 100% convinced he is on the spectrum). Half of the appointments I take DS to the docs speak to him like he has no language/intelligence. Because autism is on the chart. The idea that a kid on the spectrum could benefit from CBT is apparently entirely foreign to them. They are usually surprised he can even count. I'm not sure why his chart doesn't have his IQ on it. I have shared it with them. DS has actually expressed feeling very insulted by the way some doctors have treated him. Autism does not equal cognitive impairment.

Some of our trouble is that our regular insurance does not have mental health coverage, so we have to use MA for all such services and a very limited number of providers take it. We use the local children's hospital (which is top ranked in the nation) for most of the services we get, except for wraparound. We recently spent 6 months switching to a new wraparound provider in hopes of getting DS ABA therapy for the first time in his life, as well as getting him into their social skills group. Turns out now that we finally got all of the paperwork and pre-evaluations and who even knows what else done, DS is doing too well at school to qualify for school services and they aren't recommending ABA, which means insurance won't pay for it. Our private insurance won't cover ABA due to some loophole. This has been an ongoing issue for years and I don't think DS will ever get ABA. He has a friend who gets daily ABA at the company we switched to. This is why we switched. Unfortunately DS lost all other wraparound services in the interim and it looks like we still won't be getting the ABA. He and his friend are at very similar levels of functioning/IQ, but they have a private insurance that covers ABA.

And to top it all off, the social skills group, which sounded great on the website, is just a glorified daycare. DS needs to be in a calm environment to learn social skills, I'm looking for passing the conversation ball, staying on subject, asking follow up questions, etc. This was our 5th try at a social skills group and they have all been the same, a room full of kids running crazy and a few adults trying to get them to do crafts/follow a schedule. That is not the level DS is at! Not to mention the crying. Even I could not function in that environment!

All of the rest of our medical/mental health services are through the children's hospital. The pediatrician just refers us to specialists for everything... or ignores us. DS has severe eczema, but the dermatology department isn't even taking appointments. We've been to GI since he was little for reflux and later constipation, which got so bad it eventually led to pee accidents. He was only going twice a week and was all backed up. The only thing they recommend is more medication. I can't understand why a kid who eats so much fiber doesn't poop more. He once went over 2 weeks without a poo as a baby! And they don't seem at all concerned that it takes him half an hour to poo even though what comes out has never been formed at all. I don't really get to see it anymore, but when he was little it looked so weird and fluffy and usually had all sorts of food in it. I always brought it up to the docs. They asked if there was blood, I said no, they said it's fine. I expressed concerns he was not digesting his food well and I was worried about his nutrition, they said just give him a multivitamin if I'm worried. I had asked about a celiac test when he was maybe 2, but they said it's exceedingly rare in young children and didn't run the test.

He is rather small for his age, around 47 pounds and 47 inches. He is very thin (you can see his abs) and we have to work hard to increase the calorie count in everything he eats. The doctors want him to drink ensure, but he won't drink anything but water and absolutely hates dairy (other than cheese) or anything that has the texture of dairy. He is not a picky eater though. He eats tons of veggies and fruits, nuts and beans, meats and fish, and no sweets at all. He eats a lot more than other kids his age. I have no idea where he puts it!

He is allergic to eggs. The allergy center at the children's hospital initially refused to test him for the egg allergy because they said there is a 40% false positive rate. I refused to leave until they tested him as I knew he was allergic (he would break out in hives when exposed). It was positive, but they said it shows nothing due to the high false positive rate. They told me to give him eggs anyway as he was more likely to develop a worse reaction if we restricted them. We did continue to give him some eggs until we figured out that they were also the cause of his severe joint pain and eczema. He has not been tested for any other food allergy as they refuse to do screening tests for food allergies. DS was eczema free for a while after we eliminated eggs, but now it is back again and we can only keep it under control with prescription ointment twice a day. And it's still not fully controlled. I have considered doing an elimination diet, but DS eats so many foods I'm not sure where to start!

Since we moved a year and a half ago, we are now close to another children's hospital network and I am in the process of switching over to them. We have a dermatology appointment in March and if that goes well we are going with them for everything. The network we have been using is the same one that originally diagnosed him with ASD (dev peds) and refused to diagnose and treat his ADHD (hyperactivity is part of autism, so they would not diagnose clear ADHD) and said the only medication option they were willing to pursue after the 2 we had tried was risperdal. I had to go out of pocket to get the ADHD diagnosed, but once we got the diagnosis and started the med we were able to continue getting scripts through the pediatrician. We have not been back to the dev peds since.

Another fun fact, the dev peds and other specialists gave me scripts on multiple occasions for the alert program through OT, but their OT provider does not do the alert program. Each time we would go in with the script, be told how annoyed OT therapist is that they keep getting these scripts, and told DS does not qualify for medical OT either. He also does not qualify for school OT because he does not have any fine motor concerns. Yay.

Some friends of ours have had great success with interactive metronome therapy, which the children's hospital we are switching to offers. I wonder if their OT also offers the alert program? Or if they do CBT? We went in for an appointment with the psych at the top rated children's hospital and I begged them in person to try CBT for my son, but they said no. They did however work with his dad on parenting skills, which helped a bit. But it was all behavioral stuff as usual.

I feel like this reads like a giant complaint, but I'm so frustrated at not being able to get DS what he needs. We are saving up some money from not having to pay for the private school anymore, but we have 2 serious (and expensive) house maintenance things we need to pay for before we can afford to pay for out of pocket medical expenses for DS. If I can't find anything through MA I'll do my best to save up to pay for something over the summer. We have paid for therapies in the past, speech (for social speech) and some sort of dubious play therapy, and the costs add up fast! I don't understand why we have such trouble with the top ranked children's hospital. They must be good, right? Maybe they have gotten too big... Or maybe DS is just too much of an outlier? One thing they always do is give me a list of providers to contact for services such as ABA/speech. Unfortunately (other than stuff in their own network) they have never given anyone who takes our insurance! When I have brought up the insurance thing the docs always say that unfortunately they don't know about the insurance side of things. Too bad there is no program to match a provider with a patient's insurance!

But at any rate, your stories and advice are greatly appreciated. I will renew my fight for CBT now that DS is 8 and I will look into all of the other info/links. When you have a child you just never think you could end up with a kid like this. You understand your child could have a mental or physical impairment or a debilitating mental illness or a genetic disease. It's a small chance, but you have an awareness of the possibility. But I never thought, hmmm, maybe this baby will have autism, TS, ADHD, mood and anxiety issues, severe behavior problems, and generally be significantly neurologically impaired, but also be crazy intelligent to a degree that actually worries me. I often wonder if the impairments somehow inadvertently caused the high IQ or if they are totally independent. How much of any of it is genetics and how much was something going wonky in early development? Is this the expected result from the crazy combo of me and his father? It's not like our families have a bunch of super weird crazy geniuses running around! I'm not saying we are normal either, but we all made it through school without getting kicked out or needing full time assistance or mastering a few grades ahead without formal instruction. I know I should love my kid just how he is, but if I could trade 30 points of IQ for 30 points of normal, I'd do it. Not for me, but for DS. I just want him to be happy and healthy and right now he just isn't

SaturnFan, I sent you a pm.