It doesn't seem "logical" that a child can behave well at school but not at home, but of course, all of us — grownups included — tend to "behave" well in public and come home and kick the proverbial dog, growl at family members, and either go into a frenzy of housekeeping to get rid of our tension, slump into a do-nothing funk and let the dishes pile up to the ceiling.

Take a look at http://www.bipolarchild.com/Newsletters/ , which are authored by Janice and Demitri Papols. In the "In Honor of Mothers..." newsletter, thy note that a child with bipolar disorder " often does well in the outside world, only to return to the safe harbor of home to rage at a parent (most often the mother), leading to the suspicions of outsiders that "Something must be going on in that household, and with that woman;" or "She seems so nice, but you never really know people;" or "He can keep it together at school, so he must be a very manipulative kid." In "24: A Day in the Life," they describe how kids with bipolar disorder may have disastrous school experiences — or — "some parents don't have to worry during the school day, as their children seem to be able to keep things together in the outside world and save all their pent-up frustration and anger for the mother when they get home." The sections from 3:00 on go on to describe and explain the contrasting behavior at home.

Hope this helps. It's always good to have a doctor who's thorough and thoughtful, but it's also important to work with a doctor that gives you a sense of confidence in arriving at a diagnosis and treatment. It shouldn't take months to notice whether or not Ritalin or Concerta are making a positive difference. When we started my child on Ritalin, her doctor told us to start with mini-dose, and if we didn't notice any difference after for or 5 days, to increase a little; the point was that different kids need different doses (it's not size/weight related), so we might have to continue increasing to reach a therapeutic dose — or decide that it wasn't the right med for her. In our case, it took 8 days to fight the "right" dose. If you aren't confident in your child's doctor, see a second opinion.

Daunna Minnich
Moderator, JBRF Education Forum