Thank you for the replies to the questions and the added information. It helps a lot. I believe I can now be of help with this issue.
All right, you clearly don't think he has developmental problems like Asperger Syndrome. No attachment disorders. Good. We're back to the mood disorder.
I am more in agreement with the ER doc. But it's easier to be now that the stimulant hyped him up. That's the thing about ADD: stimulants would normally hop up a person. But a sign of ADD is when stimulants calm them down. So his going wild is an indication (not authoritative, but an indication) that ADHD may not be the working diagnosis here.
BD is a good attempt. With teens there is so little certainty with any diagnosis: teens who are doing well are changing so fast and their personalities and moods are so different all the time, tests are tough to use as certain measures. So we go by the extremes of behavior. And BD sounds possible here. That he's grumpy is okay, because he's not raging. That's a good sign. You want to monitor the meds for another week at least and make sure you're dispensing them and he's not cheeking them (keeping them in his cheek and spitting them out later). Keep him with you for a few minutes, drinking water and talking with you.
The next step is to get to a psychiatrist for a thorough evaluation for BD. That should include interviews with him and you and gaging mood charts and other things. So ask his doctor for a referral to a psychiatrist who is recognized as being experienced and great with teens with mood disorders.
It sounds like he's still functioning in school enough that we're not going to be discussing residential facilities. That's good. He can't focus for now. He needs to be told this is temporary. That's what the psychiatrist is going to be needed for: to adjust the medications and fine tune which ones he should be on and the dosages. But the main thing is that the raging has stopped.
You should ask the psychiatrist also for a referral to a psychologist who he/she thinks is great with teens. Your son needs someone who can help him begin to get to some mood management skills and to better ways of dealing with emotions.
Okay, I wish you the very best!
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