Question: What am I supposed to do if I can’t tell if my child’s behavioral symptoms are being caused by mood instability or temperature dysregulation?
Answer: You are not alone in looking for answers to this question! This is a really difficult distinction to make and it often takes parents and caregivers years to really be able to tell the difference. So, don’t beat yourself up if it takes time for you to get the hang of it.
There’s a short and a long answer to this question.
The short answer is: When in doubt try a cooling strategy (remember, “cooling” is about bringing the body’s temperature into balance, not making the person cold!). If it works then you know the symptoms were temperature driven. If cooling strategies don’t work, then you’ve done no harm and can try mood based interventions instead.
The long answer is (actually pretty long!):
While often difficult to distinguish between, there are some distinct differences between mood and temperature driven symptoms. If you’re seeing defensiveness, aggression, and oppositional behaviors that seem to be a reaction to something in the environment (even if you don’t think it’s an appropriate reaction) it’s probably not a mood response, but a temperature driven one.
For example if you interrupt your child while they’re watching TV to tell them it’s time to take a shower they may refuse, scream at you, throw the remote control at you or the television, and thrash and kick if you try to physically move them. This is certainly not a reasonable response to being told it’s time for a shower. But it is a direct response to being told to go to bed. This means that it’s possible that they’ve completely misinterpreted the request as a threat and they react according to that misperception. This happens when temperature is out of whack and triggers the fight-flight-freeze response when it’s not needed, meaning this behavior it could very likely be temperature driven. In this case body temperature regulating interventions like cooling strategies can be very helpful in de-escalating the symptoms and making your child able to carry out instructions with support.
On the other hand imagine your child is having a normal evening at home and despite the fact that nothing at all has transpired out of the ordinary by bedtime they are tearful and expressing the belief that no one loves them, needs them, or wants them around. This may make them irritable and refuse to go take their shower before bed. But the impetus for feeling so sad doesn’t have any experience in the environment that could possibly have caused it, so it’s likely mood driven.
In this case a gentle and empathetic approach that acknowledges the impact of their mood disruption us warranted. You can read more about this in our posts on the Palliative Parenting approach.
To help you distinguish mood from temperature symptoms we’ve gone into more detail below on the types of symptoms that stem from mood disruptions versus temperature disruptions and you can always find more information in our member’s resource library archive.
Mood disruptions in children with bipolar disorder usually occur rapidly, unexpectedly, and without a clear cause. They include symptoms of depression and mania (or hypomania).
Depressive symptoms include feelings of sadness, irritability, loss of interest in pleasurable activities, and feelings of worthlessness and helplessness.
Symptoms of mania include racing thoughts, irritability, distractibility, goal directed fixations known as “Mission Mode”, and grandiosity. (Hypomania looks similar, with reduced intensity.)
In children, symptoms of depression, mania, and hypomania can also present as chronic irritability, crankiness, a quick temper, as well as rigidity and refusal to try new things.
Mood swings happen quickly, sometimes without any warning or outside stimulus, and can change multiple times throughout a single day.
Put simply, thermodysregulation is the body’s inability to correctly regulate its temperature. This is a physical symptom that’s measured in the disruption of the normal ratio between the body’s core and peripheral temperatures.
Often, the child feels hot and sweaty in normal room temperatures. These neutral ambient temperatures don’t feel so neutral to the child and they feel excessively hot in the evening and cold in the morning.
Other telltale signs of temperature dysregulation are bright red ears that are often warm or hot to the touch. Another is a refusal to wear weather appropriate clothes, for example wearing shorts or not wearing a coat in cold winter temperatures and experiencing little to no discomfort when exposed to the cold.
This disruption in body temperature regulation leads to several other symptoms.
Sleep/wake disturbances are categorized in three different ways:
- Issues such as sleepwalking, sleep talking, night sweats, bedwetting, and teeth grinding, which demonstrate problems with the proper execution of sleep cycles.
- Frequent and recurrent nightmares and night terrors themed with pursuit and/or abandonment with violent and often gory imagery involving scenarios where they or someone they love is being hurt, maimed, or killed. These images may linger with the patient long after they awaken and may plague them throughout the day as repetitive intrusive thoughts.
- Alterations in circadian rhythms, including difficulty falling asleep, difficulty staying asleep, and difficulty waking.
Falling asleep: it’s very difficult for the child to “wind down” in the evenings and prepare for bed as they experience rising energy levels, anticipatory dread about being unable to fall asleep, and anticipatory fear of nightmares.
Staying asleep: restlessness includes frequent middle of the night awakenings, trips to the bathroom, and bedsheets, pillows, and pajamas in wild disarray.
Waking: they often do not appear to have the energy to move in the morning when awakened.
The part of the brain that controls temperature regulation is the same part of the brain that controls the activation of the fight or flight instinct. As a result, children with thermoregulatory disturbances experience a triggering of their fight or flight response when it’s not needed, causing them to feel intense anxiety and fear. The child is on constant alert, looking for threats and dangers, causing separation anxiety, fear of germs, fear of intruders, or of the dark to be pushed to debilitating degrees. They create elaborate rituals at bedtime, mealtime, or bathtime to help them feel safe.
Functioning in a near constant state of fight or flight also results in distorted reactions to normal stimuli. They experience threats that don’t exist, either by misperceiving something neutral in their environment as threatening, or by feeling excessively defensive from feeling embarrassed, misunderstood, unheard, dismissed, or rejected.
All children can be aggressive at times and it can be difficult to differentiate clinically significant aggression from either normal childhood behaviors, or from other diagnoses.
It’s developmentally normal for young children to have tantrums. However, in a child triggered by thermodysregulation their tantrums continue for many years past what is considered developmentally normal. The tantrums also can last for several hours and are accompanied by physical and verbal aggression, such as screaming, throwing things, slamming doors, putting holes in walls, kicking, hitting, biting, and scratching. These behaviors escalate with the child’s age to include cursing and verbal threats.
Parents know when their child’s tantrums are unusual and deviate from the developmentally normal outbursts that occur in early childhood.
Aggression is also shown in other ways such as defiant and oppositional behavior and refusals to follow simple instructions, complete expected tasks, and do basic chores such as teeth brushing, showering, homework, and getting dressed. Requests can be met with verbal abuse which can quickly escalate into tantrums, leaving parents, siblings, and caregivers feeling as though they are walking on eggshells all of the time.
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