Need help with what could be wrong

"jk9601" wrote in message
lkaboutparenting.com...
I have a 7 year old daughter who has been diagnosed with numerous mental
health issues. Bi-polar, ADHD,ODD,and anxiety disorder. She has just
recently been tested by a school pyhsical therapist and I have been told she
has lower leg weakness and doesn't like to turn her torso when needed in
activitys. When she was born she had a cyst near her spine that has since
been removed. I am just concerned that there is something more going on than
all these diagnosis, like one big thing. If there is anyone with anything
they think might help it would be great. Thanks!

A physical examination by her doctor should be your first step.

I have a 7 year old daughter who has been diagnosed with numerous mental health issues. Bi-polar, ADHD,ODD,and anxiety disorder. She has just recently been tested by a school pyhsical therapist and I have been told she has lower leg weakness and doesn't like to turn her torso when needed in activitys. When she was born she had a cyst near her spine that has since been removed. I am just concerned that there is something more going on than all these diagnosis, like one big thing. If there is anyone with anything they think might help it would be great. Thanks!

You don't mention how she was assessed and diagnosed. If the school
did it, beware, beware, beware.

Our middle child has what is termed a nonverbal learning disability,
that is sometimes classed as an autism spectrum disorder although he
does NOT in anyway have what we all think of as autistic
characteristics. He does NOT have attention deficit disorder or
obsessive compulsive disorder, however, kids with NLD can certainly
LOOK like they do.

You need a real expert to make a proper diagnosis - it is often
missed, or totally misdiagnosed and mishandled - which is what
happened to us. High priced help at the school were totally off base
and didn't know what they were talking about. Ultimately, because we
were so frustrated, and our son was in such distress and tanking
academically, so we got a referral to a child psychiatrist at a big
and respected institute - and she reviewed everything that had been
done to date, ordered a mountain of tests (i.e. all kinds of
psychological, perceptual, intelligence, as well as physical tests),
got teachers and us to fill out questionaires, sent someone to observe
him in school, spent tons of time with us AND him etc. etc. and
finally figured out what it was - and then she sent all the results to
a real expert in this kind of learning problem to see what he thought
and arrange for him to talk to us.

Understanding what was going on made a world of difference for us and
our son. We were finally able to get the right kind of help for him,
and get the school to give him what he really needed (as I said
before, they were clueless, even though they had the school board
psychologist involved). We're all doing MUCH better now - he is grade
4, and doing great at school and much, much better on the social
front. Its a brain wiring thing, so he'll always be a little off the
beaten trail, but we no longer despair about his future.

Mary G.

jk9601 wrote:
I have a 7 year old daughter who has been diagnosed with
numerous
mental health issues. Bi-polar, ADHD,ODD,and anxiety
disorder. She
has just recently been tested by a school pyhsical
therapist and I
have been told she has lower leg weakness and doesn't like
to turn
her torso when needed in activitys. When she was born she
had a cyst
near her spine that has since been removed. I am just
concerned that
there is something more going on than all these diagnosis,
like one
big thing. If there is anyone with anything they think
might help it
would be great. Thanks!

The lower extremity weakness should be evaluated. It may be
a completely seperate issue in the spinal cord or may be
related if it is true and comming from the brain. If the
latter it may be considered part of the same root issue but
I doubt it will change the other diagnoses. I do not share
the degree of cynicism of Mary Gordon but do agree that a
complex case such as this should be evaluated by experts -
possibly a peridatric neurologist and a developmemental
specialty clinic at a University hospital.

--
CBI, MD

On Sat, 28 Feb 2004 15:43:41 -0600, "jk9601" wrote:

I have a 7 year old daughter who has been diagnosed with numerous
mental health issues. Bi-polar, ADHD,ODD,and anxiety disorder.

I would be very skeptical of someone who would diagnose bipolar
disorder, ADHD, and ODD all at once. Certainly it's not impossible for
a child to truly have all three disorders, but there is so much
overlap of the symptoms in a child that young that it is more likely
that the child has only one or two of those diagnoses with just some
features of the others. A common scenario is for a child to be
diagnosed first with ADHD, then ODD, be difficult to treat, then
finally diagnosed with bipolar disorder as the revised (rather than an
additional) diagnosis. Anxiety disorders, however, commonly co-exist
with all three of the other diagnoses and are important to address.

She has
just recently been tested by a school pyhsical therapist and I have
been told she has lower leg weakness and doesn't like to turn her
torso when needed in activitys.

Missing information, of course, is why she was tested by the physical
therapist to begin with. Physical and occupational therapists will
often manage to find SOMETHING "wrong" with a child they evaluate, so
you have to first raise the pre-test probability that there is
something wrong by being very selective in your referrals. What was
the specific question for evaluation that was posed to the physical
therapist? Did someone notice her legs were weak? And what do you mean
she doesn't like to turn her torso? She doesn't LIKE to or she CAN'T?

I remember a patient of mine who was mistakenly enrolled in some
hyperbilirubinemia follow-up program at the hospital she was born at
because they thought she had had a peak neonatal bilirubin level of
25, when it actually never went higher than 18. I wasn't even aware
she was going there until I got their report, a few weeks after I had
reassured the family that her eating habits were normal for a
one-year-old, that she was growing just fine despite their requests
for an "appetite stimulant," and her physical examination was normal.
To my surprise, the therapists at the follow-up program had told the
family that she had diffuse hypotonia and sensory integration disorder
and had referred her for physical and occupational therapy, as well as
an evaluation by a nutritionist! Never mind the fact that they're
undermining all my work with them or that they don't understand the
"bell curve" of normal muscle tone and weight is shifted low in kids
from India -- what about stressing out these parents!? My partner
laughed at the report that said she had a stance indicating "truncal
hypotonia" -- he said, "She probably had a diaper full of poop!" I
called the family and, fortunately, they agreed that she was just
fine, and they canceled their therapy appointments. And guess what --
she's still just fine.

When she was born she had a cyst near
her spine that has since been removed. I am just concerned that there
is something more going on than all these diagnosis, like one big
thing. If there is anyone with anything they think might help it would
be great. Thanks!

I think it is always a good idea to apply Occam's razor and try to
find the one major malfunction that is causing all of a kid's
problems. If she truly has all of these neuropsychiatric conditions as
well as an abnormal neurologic examination, and a neurosurgical
history too, I would consider getting a brain and spinal MRI and have
her evaluated by a pediatric neurologist if I were her pediatrician.

PF