Mania Symptoms

georgiabpmom

New Member
Someone pm'd me about how to recognize mania in a small child. This post is a portion of what I replied to her and figured it might be good to post here.

I did not come up with this acronym - I have seen it in several articles on Medscape.com. But it is a handy acronym to spot specific symptoms of mania, with my own explanations or examples of how they would manifest in children after the letter's meaning. I use the initials when I chart to see more specifically the actual symptom that my son was having (instead of just marking "high" or "low" mood).

DIGFAST

D - Distractibility (inability to focus, easily switches from one idea or task to the next - leaving work undone)

I - Insomnia (more accurately, the reduced need for sleep or sleep disturbances in general)

G - Grandiosity (can be delusional or out of touch with reality like insisting that he is the President or that he can fly a plane... or milder, like being extremely bossy or wanting to control everything, trying to tell the teacher how to teach, refusing to accept instruction from you and insisting he knows how to do things you know he can't... my son at 3 would tell the teacher she wasn't teaching properly (he could read at age 3) and would tell me that he could cook Thanksgiving dinner for our entire family all by himself.)

F - Flight of Ideas (racing thoughts usually manifested by the child appearing confused or talking about multiple topics (often with wild or outrageous themes or ideas) in rapid succession - goes along very closely with pressured speech "S" and grandiosity "G")

A - Activities become goal-oriented (seems to contradict "D" but also a sx of mania - obsessive activities with an end result in mind, like doing puzzles obsessively, building with legos, doing housework or homework... adults very typically display this sx by rearranging furniture or redecorating frequently)

S - Speech becomes rapid or pressured (things coming from the mouth seem garbled or going really fast as if to try to keep up with the thoughts coming from the brain - often sounds like stuttering and the child seems frustrated if he is interrupted or can't complete a thought before another one intrudes)

T - Thoughtlessness (includes poor decision making, risk taking and hypersexuality. In a young child, this might be trying to jump out of a moving car, climbing too high in a tree, trying to fly like superman from too high heights, masturbating, touching private parts of others and laughing or finding it funny, choosing to disobey known rules without thinking through the consequences, wanting to buy everything in sight or melting down over not being able to buy something in a store...)

In children, ALL of these symptoms are almost always accompanied by irritability and frustration.
 

isitbedtimeyet?

New Member
Hi Julie,
Haven't seen you around for awhile and it is GOOD to see you again!

I had forgotten about the DIGFAST acronym and I thank you for the reminder. It will be good to include in my information packet I am putting together for the emergency IEP meeting I have requested for my difficult child. Recently he is more apt to get "stuck" in depression cycles. The Depakote keeps the mania more controllable and harder to spot initially when it does appear. The DIGFAST is a good way to spot early symptoms.

Thanks!
Hugs,
NAncy
 

jdbjdb2

New Member
Hi Julie,
I had lost touch with the CABF forums for a while as I was really focused on my weightloss surgery issues..WOW Z is in 7th grade now dang time passes my kids are like almost 15 and almost 14.
That acronym is great,I see it in my kids and actually in me,but I am working with my therapist on that...I am dealing with hypomana
Lisa
 

georgiabpmom

New Member
Thanks Nancy! I appreciate the welcome back. I'm so scattered these days, it seems. My son has also used up all 30 MH insurance inpatient days in the past 2 months plus 5 days out of pocket in the state hospital here... and is still unstable ... that's where I've been. Good to be back.

And Hey Lisa! I've wondered about you often. Are you still on the yahoo lists? Man our kiddos are getting grown fast. Z will be 13 in January, but he's already 5'9" tall (size 14 shoe!). Great to hear from you.

Julie
 

DammitJanet

Well-Known Member
Those are excellent.

Actually describe me to a T when not medicated appropriately...lol. Like you said...accompanied by irritability and anger.

yeppers...thats me.
 

Tigger2

New Member
sounds like me and difficult child to a T. i don't know why we still have this "mood disorder" diagnosis. If this is the criteria for Early Onset Bi-Polar (EOBP), then difficult child definitely has more than just a mood disorder.

Thanks for the info.
 
my son was recently ( 7-8 mos ago) discharged from an Residential Treatment Center (RTC) & threw his 1st rage since then. We think he needs a medication check ( is on Lithoboid 600 x2 per day ) & has had NO TESTING :mad: :mad: in this last 7 mos- except for WBC ( titrating down the clozaril & then stopped this past summer). I asked but then I am a mom but did suggest Lithium level...........he actually should be having more tests but this is a DR who prides herself "on saving the state $$$$$"

This was his 2nd Residential Treatment Center (RTC) & this did almost nothing for him except put him in control of the 1st yr Therapist & very young staff. He was doing well ( signs of out of contriol behavior happened about 3 mos ago?)

I happened to mention "he was acting quite manic- right in front of Therapist." & explained much of the above. All I got was "sounds like a teen to me- you do know he is NOT normal, don't you" That's irrelevant & yes, we don't have our heads buried in the sand ( or anywhere else!!!!)

Just venting--- thank you for theDIGFAST--taking it to psychiatric - if I may please????
 

georgiabpmom

New Member
Originally posted by alphamember/theresa:
Just venting--- thank you for theDIGFAST--taking it to psychiatric - if I may please????
Be my guest - like I said, I didn't come up with it... only the explanations. But I agree with you on the frustration. I had an IEP meeting about 3 weeks ago after dealing with a series of lengthy hospitalizations for my son. I hadn't broken down in that entire time, but when staff at the IEP said that Z sounded like he was doing "typical teenage stuff" I totally lost it! I started crying in disbelief that they would say this - especially after witnessing his rages and aggression first hand in school! It was the first time in over a year I had felt so attacked by this new system that I thought was doing such a better job than our previous system (we moved last year just to get away from our old system).

After I went outside and cried privately for about 5 minutes, I came back and they apologized and said they only meant they were trying to tell me that they also feel frustration with their own kids... but acknowledged that their level of frustration was nothing compared to what I had to deal with with Z. UGH!

Julie
 

Cory

New Member
Originally posted by georgiabpmom:
[qb] DIGFAST

D - Distractibility
(inability to focus, easily switches from one idea or task to the next - leaving work undone) This fits E to a T. Does impulsivity enter into it here, too? What about hyperactivity?

I - Insomnia (more accurately, the reduced need for sleep or sleep disturbances in general) E can awaken early sometimes, but otherwise I don't see it in her.

G - Grandiosity (. or milder, like being extremely bossy or wanting to control everything,
Only the controlling part is really obvious.

F - Flight of Ideas Don't see this at all.

A - Activities become goal-oriented Nope, not this one either.

S - Speech becomes rapid or pressured
E talks as little as she can get away with. I think mostly related to her language problems.

b]T - Thoughtlessness
choosing to disobey known rules without thinking through the consequences Yes, this is her. One of the major components of her ODD
wanting to buy everything in sight Has a very hard time making choices when shopping. Can't decide on this pair of jeans or the other 3, so insists on buying all 4 of them.

In children, ALL of these symptoms are almost always accompanied by irritability and frustration. Definitely E. Her major mode of operation. [/qb]
Julie,
This is very helpful for me. I appreciate you posting it and explaining things so clearly. I really wonder about E, though, and have inserted in italics how she fits into this. What do you think? Her psychiatrist has her diagnosis'ed ODD and mood disordered. We, and her school, see a lot of ADHD symptoms but her neuropsychologist said she can attend when she wants to. Does she seem like Early Onset Bi-Polar (EOBP) to you? (No, I'm really not trying to ask you to diagnose her. Just trying to see where she would fit into all this.) Her psychiatrist is very reluctant to try her on stims because she's afraid it could bring out BiPolar (BP). Can a kid be just ODD and ADHD and irritable at times without it being BiPolar (BP)?

What are your thoughts if you don't mind giving me your input?

Thanks,
Cory
 

jweb

New Member
julie -

i have never seen this acronym, but thank you for posting it. i have printed the chart - will take it to our emergency iep review meeting wednesday afternoon! has our difficult child written all over it!

thank you - thank you!

jamie
 

BusynMember

Well-Known Member
Interesting. THanks. It's like myself also, Janet, since I'm usually hypomanic, BUT not as bad as when I wasn't on medications. I know a need a mood stabilizer added (grumble, grumble). In kids though I don't think it's as clearly defined. I had the moods as a kid, but they didn't become as defined until 13, then BOOM. I was more crabby, phobic, sensitive, disobedient ("Make me!") and full of anxiety as a child...no clearcut ups or downs. Defintiely not a happy kid though. Rages: "If you don't let me____I'm going to keep my brother and sister up ALL NIGHT!" My grown sister still remembers and is seeing some of this in one of her kids (and is justifiably scared). Anyhow, thanks for this info. I"m sure it will help a lot of people who are trying to sort out ADHD/ODD from BiPolar (BP).
 

Allan-Matlem

Active Member
Julie,
Thanks for sharing your knowledge and experience here and your great site. You are a great resource here
Yours Allan
 

georgiabpmom

New Member
Originally posted by Cory:
This fits E to a T. Does impulsivity enter into it here, too? What about hyperactivity?[/i]
Certainly hyperactivity and impulsivity do play into mania, but it's probably more helpful to think of the hyperactivity as increased energy during manic episodes. When the mania is over, if it's not ADHD, the hyperactivity subsides and often turns into lethargy or very low energy. Also, the impulsivity may wax and wane with mania, especially if ADHD is not primarily involved.

b]T - Thoughtlessness[/b] choosing to disobey known rules without thinking through the consequences Yes, this is her. One of the major components of her ODD
The rule breaking is a small part of only one symptom of mania. If that's all you're seeing, my guess would be that she hasn't experienced a true mania. From my experience with my son and with talking to hundreds of BiPolar (BP) parents over the years, thoughtless behaviors are a really big part of childhood BiPolar (BP).

Kids with a full BiPolar (BP) diagnosis tend to either self-harm or take life or limb threatening risks (like jumping from a car on the highway or trying to fly off a roof, etc.).

wanting to buy everything in sight Has a very hard time making choices when shopping. Can't decide on this pair of jeans or the other 3, so insists on buying all 4 of them.
This is also a small part of one symptom - and it really seems to go more with the inability to make decisions rather than the desire or impulse to spend money. The agonizing over which ones she likes better seems to show, at least in my opinion, a slower thinking process (although problematic as well) than mania.

In children, ALL of these symptoms are almost always accompanied by irritability and frustration. Definitely E. Her major mode of operation. Can a kid be just ODD and ADHD and irritable at times without it being BiPolar (BP)?
I think so. Definitely my son has ODD moments even when his mood is stabilized. And irritability is so common with children in many disorders - and even with no disorders involved.

Overall, it seems that if your child has a mood disorder or BiPolar (BP), it may lean more toward a milder version or bp2 which is more depression than mania (but not necessarily "milder" than bp1). Dysthymia, which you list in your signature, is like combining depression with some symptoms of mania - depression with irritability, high energy levels, poor coping or thinking skills, impulsivity, etc... which sounds a lot like what you're describing than actual mania.

Of course, like you said, I can't make any kind of diagnosis. I'm just a parent. And to be completely sure yourself, it would probably be a good idea to complete a daily (even hourly) chart for a good length of time (a few months, at least) to get a better picture of what's going on. You'll feel like a lab rat at first (or maybe your daughter will? LOL) but it becomes common place after a while and really helps you to see if any patterns emerge or if she is showing any other signs of mania.

It's important to realize that BiPolar (BP), like all disorders, is made up of a collection of symptoms. And to be diagnosed fully, there has to be a certain number of symptoms happening at the same time and within a certain time frame. For mania, I believe that number is 4 and there has to be irritability or high energy associated as well. Based on what you've written about these symptoms, it doesn't seem like she would fit in at least 4 areas of mania... but you'll know better once you start charting.

Best of luck, and I hope it's helpful. Do be sure to ask your psychiatrist what he thinks of the symptoms you see or don't see in your daughter regarding mania.

Julie
 

dlp30

New Member
Thanks this is very interesting!! I have never heard this before. Gives a good explanation of the different symptoms. Some that I didn't even realize.
 
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