Mood disorder and college

Parent Cafe
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<p>Her problems are not of a nature to justify institutionalizing her. Plus, she has enough credits to graduate now if she wanted. Her entire schedule next year is made up of AP courses. She fulfilled all the requirements for graduation ahead of time. She has 28 credits now and is taking a summer course.</p>

<p>Academically, she does great. Socially, lots of issues. This past years, teachers really grew to like her. And she started socializing better. But that was mostly because I came down on her about her behavior and forced the issue, as well as her orchestra teacher and the one school counselor who saw the problems last year.</p>

<p>And yeah, she does not have the tantrums outside of the home. It all happens at home. Outside of the home, she might cross her arms and sit in the corner and refuse to speak to anyone when upset, and perhaps cry, like when it is a crowded unruly place.</p>

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<p>She’s proven she’s a student - a very good student. Don’t do anything to stand in the way of what would come next ~ entrance into a university. She doesn’t need to know a major, don’t ask. She’ll figure it out. I wouldn’t pay for a private or out-of-state. Too much risk she will find fault. Pay for any instate public, and leave it to her to make her decisions from here~ the empowerment may help. She is now an adult.</p>

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<p>I didn’t suggest “institutionalization” as in long term psychiatric care, but rather for a shorter period to get a diagnosis. I’ve known kids with were totally off-the-wall and misdiagnosed after a few sessions, but were able to get proper diagnosis, and later treatment, after stays of three days to three wekks in one case. (Of course whatever insurance you have plays a part in this too) In patient can be a more effective and surer way to get disagnosed than just time on the couch. And it would give you a bit of a respite --not something to be overlooked and sniffed at. You probably need one. But of course talk to the therapist you will be seeing and be guided by his/her recommendations. </p>

<p>And I reiterate. Worry more about her health – and yours – than her schooling right now. If her mental state as fragile as you make it sound, that is your priority and not where or when she goes to college. Please dont lose sight of that.</p>

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<p>Agree with BigDaddy as a “been there done that” mom. She needs to be evaluated by a pyschatrist, not a “counselor” and in-patient for a few days is the best way to do that and also to begin medication, which again needs to be administered by a psychiatrist.</p>

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<p>Have you considered if she might have Aspergers? She sounds very intelligent, and there can be a temper/melt-down component associated with that syndrome.</p>

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<p>As another been there/done that parent - no, she doesn’t need to be institutionalized, but she does need to be evaluated. If she happens to be having a good day when you take her in to see them for a couple of hours, they’re not going to get a good picture of what’s happening. She needs to be observed. Doing well academically has nothing to do with it - the social issue are a problem, and they need to be dealt with. </p>

<p>If she had some physical condition - maybe unexplained stomachaches or headaches - and we suggested overnight observation, would you balk? Remember, you don’t spend 24 hours a day with her, so you cannot provide 100% accurate details of what is going on. An outpatient evaluation is going to require surveys by her guidance counselor and teachers - which will take more time.</p>

<p>It would be far better to get her an inpatient placement NOW before school starts, and get her into treatment, than to wait for something to force the issue. If that happens, you will end up having to take whatever inpatient program has a bed, and may have to wait for that bed. She is old enough she would be stuck in an adult acute behavior unit until such a bed becomes available - not fun for her or you, and no progress will be made while you wait.</p>

<p>Better to get the help now, and even consider cutting back on the AP classes while she is in treatment. If she already has the credits to graduate, then the academics should take a lower priority. Look up the threads here from students with mental health issues - if it comes to a head after she leaves home, she could find herself suspended from her school, with trouble getting the support to return.</p>

<p>For you, I would suggest finding a local NAMI (national alliance on mental illness) support group, visit nami.org to find something near you. You will have someone local to talk to who understands what you’re going through. </p>

<p>I do feel for you - D is only 15, but the majority of those in her therapy group have been 17 or 18, ready for some independence. Most have had to put off starting college, or change their plans, while they learn coping skills. They all understand that without those coping skills they cannot survive college, no matter how bright they are (and some of them are extremely bright - 2400 SAT bright/4.0 GPA bright).</p>

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<p>Would it be possible for someone to discretely record her next few outbursts in the home, perhaps with a webcam or similar? This would help the therapist be able to have a more accurate view of what is going on and be less dependent on whether it happens to be a “good day” or “bad day” when she is seen.</p>

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<p>Agree with CTMom - summer is a great time to get her evaluated and treatment started. My d’s “problems” intensified summer before senior year too. She almost didn’t graduate hs but was ahead like yours and managed to get through. Took a gap year after hs. Wish I could say things are improving but they’re not. College no longer seems to be in the picture - at least not right now.</p>

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<p>As tough as these things are, I think in some ways, it’s better that they happen when our kids are nearer and we still have more options about trying to help them get treatment and follow through than when they’re 2500 or 5000 plus miles from home and racking up lots of debt while they flounder.</p>

<p>We always tried to work on health issues for our kids over the summer, as it was easier if we had to travel for providers than trying to figure out how to minimize disruption to school. </p>

<p>Best of luck to you & your family in dealing with this challenge. Sadly, a lot of these health issues seem to emerge as kids enter late teen years and young adulthood.</p>

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<p>Oh, dear. I feel like there is a lot of diagnosing going on here. My recommendation is:</p>

<p>1) get her a complete and total physical with her doctor.
2) go to family therapy so that a provider can get a complete picture from each of you about what is going on. Her problems are a “family” problem at this point and need to be addressed as such. A good family therapist will support each of you and hopefully set some behavior “norms” for the family.
3) let the family therapist recommend the next steps.
4) no harm in getting an evaluation including emotional testing.
5) make sure that one of her eventual providers if it is deemed needed will “quarterback” her care.</p>

<p>I would caution you not to make her a “patient” so quickly and make sure that any provider you choose is comfortable communicating with you as well as her. I would recommend a psychiatrist that can do meds AND therapy or at a minimum a therapist that is familiar with medications and comfortable communicating often with a psychiatrist.</p>

<p>Remember this is a family problem and you should have a lot of input and be treated with respect.</p>

<p>Also, I would choose more evidence based therapies for her.</p>

<p>Inpatient treatments can be traumatizing although necessary in extreme situations liking suicidal thoughts, etc. Inpatient treatment will only be as good as the systems they can set-up for ongoing care after. </p>

<p>On the college front, I would recommend a school where the class sizes are small and there is interaction between the professors and kids. I would look at schools close by and a few at a reasonable distance. I would keep her options open.</p>

<p>I am sorry you are going through this. I just wouldn’t jump to some of the diagnoses that are being named here without professional evaluation and time.</p>

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<p>I see a few red flags. 1) you are checking out her facebook page ; 2) you are ruling out community college because of her AP credits. I am sure she doesn’t have 2 years’ worth of AP credits; 3) you are calling things like her not responding to the counselor in class “lies” when in fact, she didn’t want to speak up in front of the class. That’s not a lie in my book. I don’t even know how you would know about that, anyway. It seems awfully specific. I never asked my D that many details about what went on in her classes. Your D seems prone to exaggeration and hyperbole, but these are not major lies, like whether she’s been using drugs or not.</p>

<p>It seems like there is a lot of unacknowledged pressure on her (about the AP classes, the essays, the SAT scores, the Tier 1 university…) I think I would have reacted the same if my mother were on me like that. It’s not the end of the world if she delays college or goes to community college first. In fact, it may work out much better for her.</p>

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<p>peacefulmom - we’re not suggesting inpatient treatment. We’re suggesting inpatient evaluation, which is entirely different. Following the evaluation, then you set up outpatient treatment, whether that is weekly therapy, or something more intense, such as an intensive outpatient therapy program (IOP). </p>

<p>Very few here have done any diagnosing, and have clearly been careful not to do so. Yes, suggestions were made as to some possible diagnosis, but that would be up to a psychiatrist to determine - and that’s where the evaluation comes in. She already has a previous evaluation indicating a mood disorder, now that she is older it may be time to clarify that diagnosis.</p>

<p>Those of us who have dealt with mental illness within our families are acutely aware of the time it take to work within the system. Unless you have a crisis, it can take months to get an appointment, and evaluations take forever. Even in a crisis situation, you still sometimes have to wait. The time to act is now, and the advantage in an inpatient evaluation (the whole process over in a few days vs weeks) will be less disruptive. Particularly with teens, these evaluations are done in a hospital inpatient wing, not in a residential facility where you would find inpatient treatment.</p>

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<p>The counselor asked her directly and she said no to having looked at colleges. He asked her because he knew she had been looking. There have been other lies, nothing that benefited her, just panicks and says something not true.</p>

<p>SHE is the one who is insisting on tier 1 university, not me. She says no way would she attend any of the schools near us. She will have 11 APs completed, some worth more than 1 course, by the time she finishes. At the state university, she already has near a years worth of credits. She has been taking AP courses since 9th grade. No one forces her to, she choses this.</p>

<p>And also, I consider it irresponsible when parents do not check on their children’s internet activities, or any other activities in public. And since she was actually flying off the handle over what she claimed to read on FB, I checked it. I do not approve of the un-parenting style of “parenting” as it is just a failure to parent. If a person is not willing to parent their child, the person should just not have a child in the first place.</p>

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<p>I don’t think we need to start second guessing the OPs parenting here. When my kids were under 18 we had usernames and passwords to all social media and email accounts. We did a sweep periodically. They were aware of this. If my child was unreasonably inconsolable I wouldn’t think twice about looking at the information they were basing their crisis on, especially if they had a history of not seeing things for what they really were. The OP was able to talk to her DD with the information that it wasn’t ‘everybody’ but ‘one person’. She didn’t read a diary or go through text messages covertly to get this information. My guess is her access to her daughters Facebook is no secret and completely on the up and up. </p>

<p>As for the APs adding to two years, don’t be so quick to judge (and really, why does it matter here?). I have a son applying this year who will graduate with 10 APs. He’s applying to a wide range of universities. He would be awarded a vast difference of credits, the highest being 44 credits. That’s three solid semesters. The OPs DD has an additional class that could be as much as 8 credits. At this point you’re closing in on four semesters (52 credits).</p>

<p>I do believe people have been very careful to state:
A: get a full medical evaluation
B: get a full psyc evaluation from a psychiatrist, not a therapist. This would preferably be done through a hospital specializing is psychiatric diagnosis, but that’s not always possible based on availability and location
C: no one has suggested in patient treatment.
D: a few have discussed various mood disorders based on their own experiences, explained some basic differences, and urged formal medical diagnosis. </p>

<p>While this does indeed involve the entire family this is not an intervention to coerce good behavior from the OPs DD. Taking the whole gang to family therapy is a sure fire recipe for her to clam up, feel punished, alienated, betrayed. She needs diagnosis, and a treatment plan that includes someone she feels 100% safe talking to that nothing is repeated. This can’t be someone anyone else in the family is seeing. In time, family therapy may be indicated, but that’s not the first line of treatment. FWIW, during any full evaluation there will be an extensive questionnaire for the parents, as well as an interview asking questions about relationships at home, pregnancy, early development, it can be very intense. If you’re honest (which you are to best help your child) they get a very good idea of family life.</p>

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<p>“We’re suggesting inpatient evaluation, which is entirely different.”</p>

<p>Your insurance company probably won’t think so. Of course, paying cash would be an entirely different matter, but you might want to look for a place used to that. Not many, in my experience. *</p>

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<p>The OP asked for suggestions, and in my humble opinion the family should be seen by a family therapist as soon as possible. The last goal of family therapy would be to “coerce” good behavior, but instead would provide a safe place for the family to communicate. I agree with most posters that the OP daughter should have a complete evaluation. Diagnosis and medication and individual therapy can take a very long time to work and to get into place. In the meantime, family therapy is more accessible and could provide some relief for the OP and her daughter. The family is in crisis (and will likely be more so when school begins) and needs support.</p>

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<p>Really informative, thoughtful responses on this thread. </p>

<p>I have a few friends who have been through similar issues with children late in the high school years. My take has been that it was most helpful when the parents dropped college off the table until everything else settled down. None had a good outcome when their kids forged ahead with college in the midst of emotional/mental turmoil. The kids ended up back home at our excellent CC, having blown big sums of money on out of state (gotta get away from my parents!) tuition that yielded a lot of failed or dropped classes. </p>

<p>Just take care of her insides first. College will come in time, and she’ll be great when the time is right. Not that you need to even talk about it yet, just stop thinking about it in terms of “fixing” things in the next year.</p>

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<p>Shrinkrap - my insurance company does in fact consider inpatient evaluation as different from inpatient treatment. One is a temporary situation, where they often approve a short-term stay, the other is long-term, and expected to last much longer. </p>

<p>Insurance coverage is an important matter, but I would think the OP would be more concerned about her daughter’s long term health than the cost of treatment, particularly if it means avoiding the cost of a possible breakdown at an OOS Tier-1 college. With a previous diagnosis of a mood disorder in hand, I would be concerned about the problems escalating into a crisis where the family has far less control over where and when she is evaluated. Been there, done that.</p>

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<p>“my insurance company does in fact consider inpatient evaluation as different from inpatient treatment. One is a temporary situation, where they often approve a short-term stay, the other is long-term, and expected to last much longer.”</p>

<p>The evaluation is the long one? I assume you mean they also cover both, and at the discretion of the family or referring provider. That is amazing! I would LOVE to be on their panel. Getting young people hospitalized around here can be a nightmare!</p>

<p>I don’t have an opinion on this case one way or the other, but this is from American Academy of Child And Adolescent Psychiatry</p>

<p>Comprehensive Psychiatric Evaluation
<a href=“http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Comprehensive_Psychiatric_Evaluation_52.aspx[/url]”>http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Comprehensive_Psychiatric_Evaluation_52.aspx&lt;/a&gt;&lt;/p&gt;

<p>11 Questions to Ask Before Hospitalization
<a href=“http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/11_Questions_To_Ask_Before_Psychiatric_Hospitalization_Of_Your_Child_Or_Adolescent_32.aspx[/url]”>http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/11_Questions_To_Ask_Before_Psychiatric_Hospitalization_Of_Your_Child_Or_Adolescent_32.aspx&lt;/a&gt;&lt;/p&gt;

<p>Understanding Your Mental Health Insurance
<a href=“http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Understanding_Your_Mental_Health_Insurance_26.aspx[/url]”>http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Understanding_Your_Mental_Health_Insurance_26.aspx&lt;/a&gt;&lt;/p&gt;

<p>(Cost shouldn’t necessarily deter you, but it costs about $7k/8 days)</p>

<p>and </p>

<p>Continuum of Care
<a href=“http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/The_Continuum_Of_Care_For_Children_And_Adolescents_42.aspx[/url]”>http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/The_Continuum_Of_Care_For_Children_And_Adolescents_42.aspx&lt;/a&gt;&lt;/p&gt;

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<p>I recently read “The Overachievers- The Secret Life of Driven Kids” by Alexander Robbins. One of the students she profiles was nicknamed AP Frank by his classmates, for obvious reasons. It might be worth checking out.
I don’t think it is ‘un-parenting’ to allow your almost-adult child to have a little bit of online privacy vis-a-vis facebook. In the past, teenagers had diaries, and they were secret for a reason. That being said, that generation hardly uses facebook anymore for their social media needs. Monitoring your kid’s facebook isn’t going to yield much useful data. They use sites like Snapchat that disappear after 3 seconds.</p>