AS meltdowns and anxiety - can it look like bipolar?

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I just got done meeting with my son's old psychiatrist. I've been trying to set up the meeting since before I knew his office was closing and I'm really glad I met with him anyway because something seems way off to me.

I'm trying to meet with all his care providers because I think he's AS.
he lives with his dad, and his dad is a jerk.
during the inpatient treatment that was his transition to living with his dad, he was dx'd NLVD and I thought the bipolar dx was removed, but it's still on his chart.
apparently last spring, his medications for bipolar were adjusted because they said he was having manic meltdowns.

but, in my journal I wrote the things my son told me were going on. his dad was provoking him to meltdowns FOR FUN. I know he's capable of it because he used to do it to me. he thinks it's funny. he also kept leaving my son alone all day, which is something that caused my son a lot of anxiety.

can AS meltdowns seem like a bipolar phase? has anyone ever seen or heard of this?

I've been wondering the same thing myself lately. My son is a diagnosed Aspie and occasionally shows some signs of bipolar, especially during a meltdown. Just last night he threw a massive fit because it was bedtime and he started screaming and crying "I can't take it anymore," and within about 2 seconds he started laughing hysterically and wanted to us to catch him while he ran upstairs. I've never seen anyone switch emotions so radically and so fast. We are also concerned because my mom had bipolar as well as my aunt, my uncle, and my grandparents on her side. The genes are clearly not in his favor .

He's still so young (almost 5) and I'm very hesitant to take him to a psychiatrist for fear of him being unnecessarily doped up. Overall, he's a happy child so I wonder if this may just be a way that AS can manifest itself in some situations. Sorry I have no advice, but I'm very interested in what others have to say.

What's NLVD?

Well thank god. Most people don't fear that one bit.

IMO, yes. I think it is because the meltdown and intensity of which it comes is so fast and so opposite of the persons regular behavior that the first thing that comes to mind is bi polar.

Neither do I have any advice, but I can tell you I did that once at about age 12. My brother and I shared a bedroom, and my mother stepped in when my brother and I could not resolve an argument over who "owned" which part of the room. My mother said we would be doing what my brother wanted, and I did exactly what your son did so I could have my way. Completely shocked and baffled, my mother relented and I immediately stopped and quietly got up out of my huddle in the corner of the closet and smiled and thanked her ... then just walked on out of the room.

I was diagnosed manic-depressive at age 27 back in the day before the term "bi-polar", but I have no idea which might be what in relation to my self-diagnosed AS.

Yes, AS meltdowns can certainly look like what some psychs consider pediatric bipolar (which is a controversail diagnosis). I myself can have really rapid mood swings when melting down. This is not bipolar, but in adults this diagnosis shouldn't be made if the (hypo)manic epsode doesn't last at least a few days, which in my case it doesn't (it's only like a few hours), and besides it doesn't meet classic bipolar symptoms. It seems however that in pediatric bipolar, the diagnosis is much broader and includes rapid mood swings and often more irritability rather than euphoria.

I think that Bipolar and ASD should be mutually exclusive. While they can look alot like each other and share traits, there is some major differences.
Meltdowns are essentially panic attacks. The difference I can tell is if a person with ASD is under alot of stress, they may seem to be in constant meltdown mode, which may seem bipolar.

I had ASD and my brother is bipolar...I can tell you the differences are usually pretty vast. While he did isolate himself and did not like social interaction, he was always much more charasmatic and funny than I was. Oh...can he get psychotic, absolutely.

With my meltdowns on the other hand, it was like seeing somebody crack, and it took alot. There was always high anxiety.

I would say if your son was diagnosed with both NLVD and Bipolar try to find a doctor who will stick to one diagnosis. I don't think he can have both. I will tell you because of the nature of NLVD, that your son is hard wired for anxiety. There has been evidence that anti-anxiety (or any psychoactive) drugs don't really work with NLVD. In reality the abusive relationship with his father has probably caused some form of PTSD (a severe anxiety disorder). If the anxiety is not treated correctly, and misidentified as bipolar, the treatment is probably improper.

My advice: Find another Doctor, preferably a neuropsych. I don't think he has both. Unless he is very charasmatic and can read body language better than most NT folks, I don't think he has bipolar. I have had alot of people in my life who were bipolar, while there are similarities there are also very massive differences. I don't buy ASD (especially NLVD) and bipolar are co-morribund. If anything, the stress caused from the relationship from his father had a severe negative effect exaserbating the already anxious tendancies of NLVD.

Also the question that needs to be asked, was it a neuropsych or neurologist that diagnosed the NLVD. Was it based soley on behaviors? I will tell you there are alot of psychologists and psychiatrists mis-diagnosing NLVD right now, when it really should be strictly neurologists and neuropsychs diagnosing it. It's not just behavioral, if the visual-Spatial-motor difficulties are not there...its probably not NLVD, but rather something else.

Also, I am a firm believer that NLVD is a PDD. I also don't think it is a less severe form of AS, its just as severe and sometimes more severe. But I don't buy the dual diagnosis of NLVD and Bipolar, it strikes me as something that should have never gone through. He either has one or the other, they lie in different places on the mental health spectrum.

Thanks. This is good to know. I'm not the OP but my daughter is going through a similar crisis, although hers is school-related, not horrible-Dad related. A couple times she's come out of the meltdown in an almost disturbingly chipper and feisty mood (disturbing because it isn't calm, it's like a "happy" meltdown which looks manic). She is under intense stress at school and we are trying to fix that.

Sometimes I have come out of a meltdown very happy/chipper. It is largely because the stress is over, I would not misread it. I would be very careful to distinguish the two. I had both the abusive parents and the problems in elementry/middle school. I melted down alot. Now while I still melt down but its severely reduced. I was much happier when a melt down was over, especially if my brain stopped cycling the negative thoughts/stimuli that caused the meltdown.

I should mention, every person I know who is bipolar can read body language and read it very very well. Better than most NT individuals. I know this from my brother and various roommates and friends. They also usually have a very normal childhood, and start out being very popular. The onset of bipolar is usually unexpected. I have also seen bipolar meltdowns, they are very different than ASD meltdowns. They happen suddenly without cause. ASD meltdowns almost always seem to be triggered in some ways. Finding the triggers can help address the meltdowns, sometimes this takes addressing the situation and changing it, other times it is working through the situation in a safe environment. Does that make sense?

NLVD and AS both share atypical emotional reactions from the onset. The other thing to note is both are sort of lifelong things. For me it was obvious. I didn't talk much as a kid, said odd things, had atypical emotional reactions. I should also mention I could not see things right. NLVD there is usually "body language blindness". While a person with AS may see it an not understand it, a person with NLVD may not even see it. Needless to say this can cause alot of anxiety problems. Those of us who learn to deal with it...use the audio assets with NLD to do so. (I should note my diagnosis now is PDD-NOS because it is not exclusively NLD, there is some autistic traits beyond the normal NLD diagnosis such as repetitive language and obsessive interests).

I should note, my partner has been doing hypnosis on me to help me with the meltdowns. It may be worthwhile into looking into a therapist who does hypnotic therapy. I heard good things about bio-feedback too.

Has it occurred to you that some of these doctors might just be clueless? Ever read that study where journalists check themselves into a mental hospital, saying they're hearing voices, and as soon as they're in, start acting completely normal? Most of them end up getting "diagnosed" with schizophrenia despite the fact that no doctor ever observes any abnormal behavior in them whatsoever.
Part of it may be an insurance issue-- they probably don't pay for inpatient treatment for NVLD. "Bipolar" may have been used as the diagnosis for that reason, even if they did know that it wasn't accurate. Hospitals aren't generally known for their accuracy like that. I've seen them write down whatever gets them the most funding, and then lie about it. I've seen them lie about behaviors and symptoms just to get more staff on a unit. Maybe they did need that staff. It doesn't make the lie any less untrue, though.
They wouldn't cancel a diagnosis that gets them paid just because the person doesn't actually have the disorder. Hospitals don't put patients welfare above their own convenience. A good hospital might put what's good for the patient at the same level as their own convenience...

My daughter was originally diagnosed with ADHD and bipolar, and then that diagnosis was changed this last summer to Aspergers (she is 6 now, they diagnosed her bipolar at age 4). The reason for the bipolar diagnosis was her behavior around the time of her meltdowns and the intensity of her meltdowns. As time has gone on, I have observed that her meltdowns, while they seem irrational, DO NOT happen randomly. There is always a reason for them....sensory overload, frustration over communication, conflicts with peers, changes in her regular schedule. Removing the triggers has pretty much eliminated the meltdowns.

My biggest disappointment in all of this has not been the misdiagnosis, but the reaction of her regular psychiatrist re: the meds after the problem was more clearly identified. I told her psych that I wanted my daughter off of the atypical antipsychotics once we had the Aspergers diagnosis. I had a feeling they weren't doing much and they are dangerous drugs! Her psych REFUSED to help me wean her off the meds..after the 3rd appointment with her refusing to do it, I did it myself. We went to the doctor last week, and I informed her that my daughter had been off the antipsychotics and that she had noticable improvement off the drugs...she was less "foggy", less irritable, more able to function and handle daily tasks. The psych STILL reacted with "I find that very hard to believe" but after a couple of rounds back and forth of arguing, I think she finally got it that I was NOT putting my kid back on these meds. Sorry doc, you're not getting your kickback from the makers of Risperdal at the expense of my child.

My suggestion would be to find someone that specializes in autism spectrum testing, and get your son re-tested. If he hasn't been given the ADOS an AS diagnosis can't be ruled out. Bipolar meds are way too dangerous to mess with unless you are absolutely certain that you have the right diagnosis. I have a good friend with a son that was diagnosed as bipolar at age 5. Looking back on it, my friend is positive that his son was actually either Aspergers or HFA. The doctors put his son on bipolar meds...now, 10 years later, the bipolar meds have caused so many permanent changes to his developing brain chemistry that he is institutionalized, and will live in an institution for the rest of his life. These meds also can cause permanent tics/seizures with long term use. And individuals who take these drugs for long stretches of time have an average life span 20 years shorter than the general population.

For someone who is truly bipolar, the benefits do outweigh the risks, so the drugs do have their place. I would just encourage you to rule out everything else so that you are absolutely positive that treating bipolar is the right thing to do. I know my child did much better off the bipolar medication...megadoses of vitamin B6 with magnesium supplements had more postive results than any meds ever did, and B6 is a heck of a lot less dangerous.

Honestly speaking they should not be diagnosing kids and perscribing them drugs for bipolar or schizophrenia before age 13, period. Often the diagnosis for children is wrong and anti-psychotics are extremely damaging in terms of development. (This should be noted to those who are medicating thier kids with AS, it is probably not a good idea). I bless my lucky stars I never went on any medication for my issues when I was a kid, I think I am a hell of a lot better off because of this. If you are wondering, I have a professional job, a boyfriend, a graduate degree and yes some assemblence of a social life. I don't talk to my parents anymore (I was sick of the abusive), but I did end up okay. Occupational and physical therapy helps, but I am very skeptical about giving behavioral medication to kids, I think in the long run its bad news. These are powerful drugs that were designed almost exclusively for ADULTS and did not take into consideration child development.

Agreed. These drugs can be very dangerous and harmful for adults as well. My mother spent the last 30 years of her life constantly adjusting her medication and she never once seemed better off for it. What started off as clinical depression treated with meds soon turned into bipolar and then all sorts of additional mental illnesses and disorders developed as well. She was on pills for anxiety, sleep disorders, bipolar, depression, etc. At one time they had her on over 20 medications (including some for physical disorders). In her 60's she developed dementia on top of everyting else. Looking back, I can't help but wonder if she had avoided medications to begin with, would she have had such debilitating mental illnesses? Even my other family members who were diagnosed with bipolar within the last 10 years had seemed so much better before any drug therapy. Lately they're both nearly out of their minds. I can't even begin to imagine the possible effects of these powerful drugs on children.

thank you all very much for sharing all the information and your experiences. I have a bit more perspective now because of reading what you all wrote. I admit I was freaking out to the point that I almost had a meltdown yesterday! I just ended up going to bed with a migraine, though

I have an appointment with my son's new psychiatrist on Monday. I don't get a say in his treatment because I don't have custody, but I am more convinced than ever that my son is not bipolar and I have a lot of information to convey to the doc that I don't think he's aware of. my son is socially awkward, can't tell how people feel, and hyper-focuses on his special interests when he's under stress. all of his extreme behaviors occurred concurrently with emotional abuse from his dad or problems at school because he wasn't diagnosed and didn't have an IEP so teachers and principals treated him like crap. he'd have so much energy and would go off like a firecracker into full meltdown, then be depressed. I suppose it could look like bipolar without all the other information, but his assessments put him absolutely somewhere in the PDD/NLVD/AS spectrum. I'm trying to get a copy of the assessment that was done when he was in inpatient treatment, to see who did it (psychiatrist or neurologist).

my son wants to come back to live with me now that he's had a taste of real life with his dad, and I want to have him back because he's not obsessed with his relationship with his dad anymore and I feel like no one is actually managing his treatment. he gets drugs from the shrink and he's in a behavioral classroom, but no one communicates, least of all my ex.

Would that be like a court-ordered custody change? I mean, would he understand that he can't move back and forth whenever he gets frustrated with one of you? Sounds like his father probably isn't responsible enough to provide actual boundaries. I'd imagine that it's extremely difficult to provide any kind of consistency when the other parent is using the kid as a pawn, and it sounds like his father is doing exactly that.
My point is, could you be sure that as soon as your son gets angry at you for whatever there might be conflict over, he won't decide he wants to be with his dad again, and then is father let him move back just to mess with you?

RE: meds.

It is important to understand that the doses given to children are FAR lower than those given to psychotics.