Expert: Joyce A. Anthony - 5/4/2009

Question
QUESTION: Hi,
I'll do my best to be as brief as possible, but this'll be long I'm sure. My son is just over 3 years old. From 8 DAYS old, he was severely "colicky". If he wasn't eating or sleeping, he was screaming. That went on until about 6 months old. Around a year old, his extremely "strong will" and amazing stubborness became really obvious. For example, he'd sit and yank on the bottom of curtains. You'd tell him no and move him away. He'd go right back. Over and over. He'd get madder and madder and yank harder and harder. Time outs never worked - he would NEVER stay no matter how many times you put him back, and he'd end up so furious that he'd bite and kick and fight. So, he's always been a "difficult" child. Well, as he's gotten older, his anger and his "tantrums" (never simple tantrums like I see other kids have) have increased and gotten harder to handle. He has been biting, pinching, scratching for a year or more when angry. He has these rage things where, if you tell him no about something, he flips out. Screams (crying), seems totally out of control, and often will come at me physically - usually to scratch with all his nails like raking. You cannot hold him during these things, he freaks. Like a caught wild animal. They go on and on until you can come up with SOMEthing to break through (right now a "<gasp> What was that noise?? Did you HEAR that? Listen!" will sometimes get him to stop - but he starts right back up as soon as he reminds himself of what he wanted that you said no to.

Most of his rage and anger is directed at me, but I am responsible for 99.9% of his care - his father does very little.

Some other things that might matter: He's very active -- always been very "busy."  He does not play with things for long before moving on to something else. He cannot transition well - going from something he likes (bath) to something else (let's get OUT of the bath now) is a MAJOR problem most of the time, regardless of how much advance warning he gets. Putting him to sleep is a problem generally (naps are horrendous) and getting him UP from sleep is a problem - particularly if you have wake HIM. He's super sound sensitive. He can't stand to be kissed (by anyone), and wipes kisses off like they are the most disgusting thing ever. He's never much liked to be cuddled and has always been tough to comfort. He hugs - but not me anymore. He tells me that he won't hug me anymore "ever." Tells me he loves his father but does not love me. (What a killer, that.) He seems to sometimes delight in really irritating me or his father. It's like a weird game. He also will sometimes (not always at all) like to hurt me - once he does something that hurts me, he'll do it again, just to hurt because now he's angry - it's like the fact that he hurt me accidentally the first time made him really mad. He's VERY bossy - like a little dictator - and gets mad, sometimes verrrry mad, when you don't do what you were told.

He's also very sensitive; a sharp (or seemingly sharp) word from a stranger, and he's ready to bawl - or does.  His emotions are really extreme - both sensitivity and anger. When he goes the bawling route (rather than anger) over something,  it's every bit as intense - he SOBS from way down deep and it's the only time he will hang on to my neck, clutching like for dear life. It's awful and heartbreaking and generally it's way out of proportion to what caused it. (Same with his anger.)

He does have days here and there where he's basically a pleasure. He mostly does what he's told (you know, he's 3!, so!), I don't need an army to back me up when I say no - he just accepts it, he's just easier.  But I sort of know that when we've had a day or 2 or 3 like that, that soon it's going to come crashing down. And it does.

He's been evaluated by a pediatric neurologist (who doesn't believe him to be autistic, and his EEG was normal too.

Does this sound like a psychiatric issue (bi-polar? Something else?) or does this sound more like a "typical" 3 year old who's on the far end of the "difficult" scale?

I feel in my heart of hearts, when going through this stuff with him, that something is "off" - something's not right if you kwim.

What do YOU think?  Thanks!

ANSWER: Hello Samantha, thank you for writing.

Some of what your son does is "typical".  For example, it is often a trait of trying to gain independence from the mother that a child will turn to the other parent for a time. That will soon change and he'll shun his dad in favor of you.  The same for the short attention span at his age.

I am concerned, however about a lot of this.  Your son is showing classic symptoms of early-onset bipolar disorder.  The rages, the sleep pattern, the mood changes, etc...  I would suggest you call a local mental health agency, or get a referral from your pediatrician, and have your son evaluated. The sooner treatment is started, the better the chance of getting this under control will be.

While you are waiting for the appointment, keep a mood/behavior journal.  In this, put the day and time (sometimes this can help, as many kids react stronger when they are tired or hungry),and tell what happened to set off the behavior, how each of you reacted and how it all ended.

There are also a couple more things to look for that may help--as well as things you can do to understand the reasoning.  This will help you deal with it better.

First, be consistent.  Don't allow him to do something one time and not another.  He needs to know exactly what the rules are and what consequences will be if he breaks them.  Instead of trying to get him to sit in time out, find a calm time and decide with him on a place where he can safely go to become calm.  When you see him becoming agitated, have him go there before he gets out of hand. This will be a calm down time rather than a punishment. Kids respond better to that.

Understand that when he reacts with anger after he accidentally hurts you, he is angry.  He is not angry at you, but himself. His age prevents him from understanding the emotion or expressing it appropriately.  Again, when he is calm, let him know that it is okay to be angry, but any kind of physical acting out will not be tolerated-and let him know what will happen if he does act out physically.

These children are actually more scared than the parents when they have a meltdown.  Everything, as they see it, is out of control.  Having as much consistency as possible, keeping your voice soft and low and acknowledging the confusion will all help him feel comfortable that you are in charge and will keep him safe. In fact, that is one reason he acts out more with you-he feels safe with you, knowing you will not allow him to harm anyone or be harmed.

Finally, try to figure out how his body works in sleep/wake cycle. Eliminating afternoon naps will help him fall asleep better at night. Bipolar children are notorious for finding waking up difficult.  Start earlier than necessary and allow him to wake up slowly.  That should help.

I hope you can use some of this.  Please feel free to write with more questions should they arise.

         Joyce A. Anthony

---------- FOLLOW-UP ----------

QUESTION: Hi again,

First, thank you SO much for your quick and very helpful reply. I really appreciate it. As you can imagine, it's a lot stressful trying to figure out what's going on AND trying to keep things on an even keel while worrying incessantly about my baby.
 Anyhow, just a few quick followups and one particularly big question.

 First, the big question: You said I should have him evaluated.  By who? What I mean is, what type of professional? A psychologist? Psychiatrist? Developmental pediatrician? Something else? As mentioned, the only thing I've had done yet is the pediatric neurologist. He DID see, once, a child therapist, who said he'd be thinking Asberger's based on my description - but the neuro had completely ruled autism of any sort out AND I don't believe he's on that spectrum at all - I just don't.

Just some followup comments now:  Consistency. I try super hard to be consistent. He's always been such a "tough" kid, that consistency and all the "proper" parenting techniques have been absolutely vital. If you give him an inch, he takes a whole mile.

I have tried to discuss with him where he wants to go as a calm-down place - I can't get anywhere. He just says "I don't KNOW, Mommy." And honestly, once you see him becoming agitated, it's too late; he wouldn't go, or, if he did, he'd destroy the room in the process.  His age is really against me with some of this, I think.

Just to clarify the hurting me thing. When he's really angry and in a rage, he hurts me on PURPOSE. He's just sooo angry that he strikes out with nails, teeth, whatever. He seems embarrassed - even if not contrite - afterward, but it's in absolute anger, not accidentally if you see what I mean. (In another part of my message I talked about what happens if he hurts me truly accidentally - I think I may have been confusing with that - they are 2 separate things.)

We've discussed punishment (usually losing a loved toy for a period of time) for striking out physically - it doesn't matter at ALL once he's raging. He's so far gone that nothing matters at that point.

Naps. I tried to get rid of the afternoon nap because it's SUCH a hassle to get him down for it and I thought perhaps he could do without it if I increased his sleeptime at night. It was a nightmarish failure. He really, really needs to sleep in the middle of the day. He's intolerable if he doesn't have at least 1 1/2 hours in the afternoon, truly. I'm absolutely guaranteed at least one big rage at night if he hasn't slept in the day.  Going to sleep at night isn't as difficult as the nap.

One final question: How does this all work if he is bi-polar? They'll want to medicate him, I guess? Even at 3? If yes, once he gets the right meds, does he go back to being a sweet, reasonably affectionate kid? Does his refusal to be kissed (by anyone), being hard to comfort, irritability, being really "busy", and all that stuff have to do with bi-polar? Does that stuff get better when properly medicated?  Really, this is so overwhelming at this point.

Any further insight would be much appreciated. Thank you SO much!

Answer
Hi Samantha:

Yes, it is all very confusing. You do everything you are taught is "right" and none of it seems to work. Believe me when I say it isn't you. These kids can't be raised in the same way as "easier" children.

You are correct--he doesn't care while in a rage. What happens in bipolar disorder is the "fight or flight" instinct is intensified.  During the times he is raging, his mind perceives danger of some sort and he does what comes naturally-fights for survival.  It does not matter that he isn't in danger, it is what his mind perceives.  In my past answer, I was referring to the times he became angry because he accidentally hurt you.

Rages can seem to come out of nowhere--and these kids go from one to ten immediately, skipping all the steps in between. Once you start keeping a journal, however, you will start to notice little clues that it may be a difficult day. You will learn to se what situations almost always end in meltdowns, such as crowded places. Many of these children have dilated pupils before a rage. The part of the mind responsible for emotions also controls pupil size for some reason. That is one thing that you can watch for, as the pupil dilation almost always occurs a few minutes before the mood reaches rage stage.

Look in your phone book under mental health and then search for a counselor or psychologist that deals with children. That is where you will find the best evaluation. At your son's age, it is possible that they will start with some type of weekly play therapy, teaching him how to identify emotions and the best way to react.  Medication will most likely be used at some point.

The activity level is actually just age behavior and will improve as he grows.Medication will help the rages. He will also be more willing to be affectionate, but some kids just don't like a lot of cuddling. He will definitely be more engaging and friendly.

         Joyce A. Anthony