Hello, BPAspergerMom! Often what you will find with an Asperger's child is that, before the Asperger's diagnosis, they will either be given a myriad of misdiagnoses to try and explain all of the symptoms that Asperger's brings or they will be given one or more correct diagnoses of comorbid psychiatric disorders (a disorder that occurs with another disorder) but these correct diagnoses do not explain everything. I would say your son is a mixture of both.
To give you a clear-cut example of the second scenario, I will use myself. I have comorbid Obsessive-Compulsive Disorder. I figured out I had OCD long before I ever heard about Asperger's Syndrome, and I was officially diagnosed with OCD a year-and-a-half before I was diagnosed with Asperger's. The OCD helped explain some of my rituals, and it certainly explained my "bad thoughts" (I'm a pure obsessional) and need to confess and pray, but so many other things went unanswered. Why did certain clothing bother me to no end? Why did I yell at my mother when she would interrupt my routines? Why did I hate being around people? Why did I have a tendency to become obsessed with a certain subject? So, with me, I have both OCD and Asperger's.
However, in many instances, you'll find an Aspie being first misdiagnosed with OCD because of their "obsessive-compulsiveness." However, OCD obsessive-compulsiveness is much different than that which is seen in Asperger's. On the same wavelength, you will often find an Aspie being misdiagnosed with ODD, ADD/ADHD, bipolar disorder, and even schizophrenia. It is possible to have all of these and Asperger's. So, your son very well may have ADHD and ODD, in addition to the Asperger's. Having comorbid disorders is a very tricky web, and it's hard to untangle what comes from which disorder. I do see one misdiagnosis, though, and that is with the PDD. Your son cannot have Pervasive Developmental Disorder AND Asperger's. It is a redundant label. Asperger's Syndrome IS a Pervasive Developmental Disorder, so he cannot have both AS and PDD. Perhaps a doctor is wavering on whether he has Asperger's or PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified), but there is no need for him to have both labels. A diagnosis of Asperger's would be sufficient.
The bipolar disorder in your son does not sound like a misdiagnosis, since you have said that he has had actual hypomanic/manic episodes. These do not occur in Asperger's. In Asperger's, the mood swings are almost always related to interruption in routine, unexpected change, and/or sensory issues. I can have a tantrum one minute, and twenty minutes later, I'm perfectly fine. Bipolar individuals aren't like that. They cannot simply "switch off" their mood. A truly manic person who is grandiose and euphoric will remain that way, even if they learn terrible news. Likewise, a truly depressed person will be depressed, no matter what good things occur around them. It's harder to detect in children, because bipolar children/teens often are rapid cyclers, and it also is often hard for an Aspie who ISN'T bipolar to tell you what made them angry. This is why keeping a mood journal is essential.
The most important thing about medications is that your son must not take an ADHD stimulant or an SSRI without taking a mood stabilizer. These medications have a great tendency to cause (hypo)mania in bipolar individuals, and the risk is usually increased when dealing with teenagers. I have not heard much about the risk of (hypo)manic episodes occurring when taking these types of medications with an atypical anti-psychotic (like Seroquel and Risperdal), rather than a mood stabilizer, so you should be sure to ask your son's doctor/psychiatrist about the possible risks of using these meds with an atypical anti-psychotic only.
As goody mentioned, I have had success with the mood stabilizer Lamictal for my Asperger's-related outbursts. I still have lots of temper tantrums and get set off by small things. However, my tolerance for annoying people has gotten to be much better. I started Lamictal the fall of my freshman year of college, before I was diagnosed with Asperger's, and I had a roommate. Needless to say, an Aspie + a roommate's unpredictability = disaster. I was in tears every day. The Lamictal combined with getting my own room was what kept me from taking a semester off. Your son may very well have success with Lamictal, but it is hard to say. Everybody's individual neurobiology is different, and that's why the field of psychiatry is so hit-and-miss/trial-and-error, when it comes to medications.
My PCP, college psychiatrist, and even myself were suspecting that I had cyclothymia (bipolar IV; a VERY mild form of bipolar disorder), but the reason that I don't believe I'm cyclothymic is because my mood swings are preempted by things that set Aspies off and they aren't continuous. They start and end as quickly as they begin. Plus, I was on several SSRIs over the years for my OCD, and I never became (hypo)manic. The "bipolar" symptoms (me talking nonstop about my "special interest," which was seen as "pressured speech" and "flight of ideas," because I ramble and have tangential speech patterns; me not being able to control the volume of my voice; my erratic sleeping patterns; and my general moodiness and temper tantrums) really were the Asperger's.
Typically, Lithium works best with bipolar individuals who have "classic," euphoric manias that are indicative of bipolar I disorder. The more one strays from having "classic" manic-depression, the greater the chance is that they will do better on one of the anti-epileptic mood stabilizers (such as Depakote or Tegretol- Lamictal is another one). Things that cause "straying" from the textbook case of bipolar disorder include: early-onset, having comorbid neuropsych disorders, being a rapid cycler, having bipolar II disorder, having mixed episodes (both manic and depressive symptoms together), having psychotic manias, and having predominantly irritable (hypo)manias (rather than predominantly euphoric ones). Your son seems to fit many of these criteria. Perhaps you could talk with his doctor about other anti-epileptics, besides Depakote. Good luck, God bless, and if you have any questions, feel free to ask!
And, goody, thank you so much for telling me about this post over on the OCD board, as well as complimenting me. I appreciate it.
-GatsbyLuvr1920-
There is a wonderful poster here who goes by the name GatsbyLuvr1920 who has Aspergers who once in a while pops in here. I believe that she has found wonderful results with Lamictal....anyway she is soooo knowledgeable and I will try to point her in your direction.
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