ADHD/ADD vs. Bipolar

Discussion in 'General Parenting' started by Lothlorien, Jan 27, 2007.

  1. Lothlorien

    Lothlorien Active Member Staff Member

    It appears to me, from reading many many posts over the years that children with ADD/ADHD have meltdowns, but not necessarily the "Raging", am I right?

    The reason I am asking is because I am slowly coming to the realization that I really don't think Missy is actually ADD/ADHD, but rather may have a form of Early Onset Bi-Polar (EOBP). She cycles and when she is cycling she can be obnoxious and hyper and really, really irritating and then can become severly emotional and if the emotional part of it continues and gets out of control, she will rage. The raging has gotten better than when she was younger and pre-dietary restrictions.

    Bipolar seems fairly dominant on my mother's side.

    What are your thoughts?
  2. Sara PA

    Sara PA New Member

    Bipolar or partial seizures...
  3. Lothlorien

    Lothlorien Active Member Staff Member

    Right Sara, I see where you are going with that. I agree that it's possible the rages can come from the seizures, but what about the cycling? The seizures don't cause cycling, do they? I'm not sure if it was an article that you posted or one that I read somewhere else, but the two (bipolr and epilepsy) can go hand in hand with each other, no?
  4. Josie

    Josie Active Member

    Maybe she has more food intolerances? People with one food intolerance can develop more as one food is eliminated.

    Your description of Missy sounds like my "easy child" and while there may be more to my easy child than food allergies, the wrong food definitely makes it worse. And it can last for several weeks from one tiny bit one day.
  5. Sara PA

    Sara PA New Member

    Do rages preceed the switch from manic to not manic phases? Having a seizure can be quite mellowing and it can last for a few hours or even days.

    As soon as I get to my other computer, I'm going to post my seizure links again in BestICan's thread about bipolar. Off hand, I don't remember the article you are thinking of.
  6. BestICan

    BestICan This community rocks.

    Lothlorian, I sure don't know the answer, but I will follow this thread with great interest as I'm in a similar situation.

    You mention bipolar in your family tree. Heredity was a huge factor when we talked with the psychiatrist about my son. I swear, it seemed he was ready to diagnose my son as having bipolar based on family history alone. (Obviously I think he was overzealous, especially since he admitted he didn't know much about seizures.) I guess it's just me, but I was under the impression that pretty much everyone had a mood disorder or history of addiction in their family tree. We have it in spades!

    I did talk to difficult child's neurologist about behavior and partial complex seizures. He told me there's no known cause and effect between seizures and behavioral issues, but that there is a higher incidence of behavioral issues in kids with partial complex seizures. I'm not sure if I understood that correctly, and we're pursuing a new neurologist, so I'll ask the question again. But, when my son was unmedicated for his seizures I could absolutely tell you when he was going to have a "seizure day" based on his behavior. And it was as erratic and unpredictable as - I think - bipolar behaviors must be.

    Regarding separating out ADHD and Bipolar, just reading the intersection of symptoms makes my head spin. I hope you have a good team of professionals to help you figure it out!

    So, sorry that I have nothing useful to add, but as I said, I'm very interested in what you find out! Good luck.

  7. Sara PA

    Sara PA New Member

    [ QUOTE ]

    I did talk to difficult child's neurologist about behavior and partial complex seizures. He told me there's no known cause and effect between seizures and behavioral issues, but that there is a higher incidence of behavioral issues in kids with partial complex seizures. I'm not sure if I understood that correctly, and we're pursuing a new neurologist, so I'll ask the question again. But, when my son was unmedicated for his seizures I could absolutely tell you when he was going to have a "seizure day" based on his behavior. And it was as erratic and unpredictable as - I think - bipolar behaviors must be.

    [/ QUOTE ]
    This is one of the things that has fascinated me over the years. When my seizure disorder was diagnosed based on the tonic-clonic (grand mal) seizures I was having, not my slightly abnormal EEG, my IBS/colitis/whatever I was having stopped the day I started an anticonvulsant. My GP, educated in the 50's, immediately knew that I had been having abdominal seizures. My subsequent neurologists and other doctors educated in the late 60's on were totally unfamiliar with the concept of partial seizures, attributing all of those symptoms to stress and psychological causes, a result on the increased emphasis on psychiatry and psychology in the '60s and '70s. I knew my old GP was right because of how I felt and how my life had changed. To a person, the younger doctors insisted it was pure coincidence that my last episode ever of IBS/colitis was the day before I took Dilantin.

    When my son was a toddler, I watched him have "tantrums" but I knew by the look in his eyes and his expression and the predictable pattern and duration (for him 45 minutes unless something continued to trigger them) of the episodes that these weren't normal toddler tantrums. I knew he was having "some sort of seizures" as I told the doctors. They all disregarded me because they had no knowledge of emotional seizures. These epsidodes continued to occur a few times a year until he was put on medication for depression when those episodes dramatically increased in number and severity. By then he was 14, taller than his father and weighted as much as me. He became violent. When I got little help from the medical profession, I turned to the computer and started learning.

    It didn't take more than one google to find a site which mentioned partial seizures can manifest in emotional explosions. This information is available in site dedicated to epilepsy and in both neurological and psychological journals. Why doctors don't know I have can't explain. It isn't new.

    Seizures are, as is usually described, short circuits in the brain. Whatever is controlled by the part of the brain that short circuits will be affected by the seizure activity. If that part of the brain controls the bowels, than you have a form of abdominal seizures. If that part of the brain controls emotions, you have an emotional seizure. My son has had a few small seizures in the sensory areas of his brain, once causing him to smell gasoline in the house where there was no gasoline, another time causing him to hear the phone ring when it wasn't ringing. Other than hearing/smelling those things, he was otherwise perfectly normal at the time. I also think he's had some seizures that have caused him to taste things that weren't there, usually a burned taste because he use to complain that food tasted burned (it wasn't) all the time when he was having a lot of partial seizure activity.

    It is very hard to tease out what is seizure activity, bipolar and psychiatric adverse reations to medication. But then, the more I read the less I believe there is much difference for some people. Antidepressants, antipsychotics and stimulants can all lower the seizure threshold. Are some psychiatric adverse reactions to some medications seizure activity for some people? I wouldn't be surprised. Unfortunately we simply don't know what is going on within the brains of our children when their behavior is uncontrolable.
  8. timer lady

    timer lady Queen of Hearts


    I would think with the hx of bipolar in your family it would be a high consideration.

    Having said that, it's in difficult children best interest to rule out any & all physical conditions (i.e. seizure activity).

    For my own seizure disorder, it took years to pinpoint by EEG the focal point of the seizure activity & the best medication to treat it.

    So many times, with the tweedles, diagnosis's were confirmed or ruled out by their reaction to medications & ongoing treatment plans. If something didn't work, we moved onto the next theory on the table.

    I'll be keeping you & your difficult child in my thoughts as you try to sort this out. :warrior:
  9. Sara PA

    Sara PA New Member

    Unfortunately, the state of the science can't rule out seizure disorders, it can only rule them in. The estimate is that only 50% of temporal lobe (where emotions are controlled) epilepsy shows up on EEGs.
  10. Lothlorien

    Lothlorien Active Member Staff Member

    Missy hasn't had a seizure since the summer, but she has cycled. Missy's seizures were generally provoked when she was sick, at least the visual ones were. She always had this look on her face and her eyes before it's happened. There has been two times since she's been on the Trileptal that I have seen the look, but no visual seizures. She was mellow.

    She'll go a week or two and just be a perfectly normal kid, (with and attitude) and then all of a sudden, she's obnoxious, loud, non-stop verbalization, sudden urges to run through the house screaming at the top of her lungs and oppositional and defiant. The oppositional and defiance hasn't been a front runner like it used to be, but is rearing it's ugly head lately.

    I took her skating today. She can't skate so I took her for lessons. After only five minutes, she got frustrated and started crying. I could tell that if this went any further, a rage would ensue. I could feel it brewing. I was trying to console her and encourage her at the same time and then I looked at the intructor with this pleading look and she came over and gave me some suggestions. Ten minutes later, she was fine, but she's been on the obnoxious, running, crazy cycle this past week.

    At any rate, I do have a follow up with the neuro on Monday. I'll let her know what I think, but I still need to go through the motions of finding a p-doctor, which is a PIA! I've been putting it off. I'm kinda glad I've put it off, since I thought and I'm sure the initial diagnosis would have been ADD or the like and the medications would have been the wrong ones if I had gone the medication route.

    I think the neuro is going to up her Trileptal this visit. Maybe that will help.
  11. WasInDenial

    WasInDenial New Member

    Hmmm.... Just some thoughts. We've also tried to rule epilepsy out with our difficult child as he is currently diagnosed as ODD. But as one poster noted, it can't be ruled out, only in. I know because I was diagnosed at 23 with Petit Mal Epilepsy with Partial Complex Seizures in the Temporal Lobe after I had a major car accident. The accident didn't cause the epilepsy but rather the other way around. I had the epilepsy since as far back as I could remember as a kid. I was then put on Depakene for about 4 years to control the seizures. It was a miracle drug and cleared it up almost immediately until I grew out of it. After two conscutive years and and 4 EEGs where the docs weren't able to induce the seizures and see it on an EEG, they pronounced me seizure free.

    Anyway, those symptoms included intense rage after being under stress and then "blowing up" and occasionally with no provocation. I can't tell you how many walls I put my fist through. I would have periods of memory loss where I would would just black out for as long as a second or too. To the outside observer I looked like I was daydreaming, but I was really re-booting but didn't know it. Right before a seizure I would sometimes experience synethesia, or the hearing of colors, seeing sounds, or a certain letter might be a certain color to me. As a kid I figured everyone saw the world around them like this. It's not like someone asks you what color the letters you see are. Especially after they give you those color-blind tests. How was I to know this was unexpected as a kid?

    The doctor at the time said the normal anger I was feeling under stress would reach a point and then the electrical impulses in the brain would cascade over the entire temporal lobe, which then caused the synethesia and eventual mini blackout and my emotions to go haywire.

    Sometimes days would go by and it wouldn't happen at all and other days it would happen 4 or 5 times an hour. When it happened frequently, I didn't know something was even happening, just that I missed a few words of what was being said. Looking back, in school it was a major handicap preventing me from learning, but I wasn't even aware of it happening. Once it was diagnosed and treated a million thing were explained for me. That in and of itself was a relief.

    I had been tested for epilepsy as a child and they didn't find it then but I had it. The trick was a really dedicated neurologist after the accident. If you suspect epilepsy, push really hard for them to do the tests really intensely. For me no matter what frequency the light flashed it didn't trigger it. For me it was really intense hyperventilation and me getting angry at them for pushing me so hard. That is when they could clearly see it on the EEG and I gazed over for brief moment.

    I've been seizure free since I was 28 or so. You can grow out of this type of epilepsy.

    Good luck.
  12. Sara PA

    Sara PA New Member

    That other poster would be me. I too no longer take medication after taking it for a few years. I no longer have seizures.

    You may want to have your son tested. Temporal lobe epilepsy which generally take the form of partial seizures run in my family.

    And, regardless of what the EEG says, you may want to try your son on a good anticonvulsant mood stabilizer (not lithium, it lowers the seizure threshold).
  13. Liahona

    Liahona Active Member

    I thought that the book bipolar child describes the difference between ADHD and bipolar well. They say that bipolar kids have longer rages than ADHD kids. They also go over the list of symptoms and have a chart for moods, energy, medications, rages, and sleep. It has really helped me to be able to see difficult child 1's cycling. It was the first I'd actually been able to see it because I'd be to caught up in the moment to remember if he'd had high energy low mood and less sleep the day before.
  14. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    The bipolar in the family is a huge red flag for bipolar. It's all over my family tree too. Seizures and bipolar can co-exist, and, although I havne't researched, I'll bet they are more common with bipolar. Some feel there is a connection between the too. My son is on the Spectrum and there are DEFINTELY more seizure disorders with children on the spectrum. These problems don't seem to exist alone, although they can. With the behaviors you're describing, I'm guessing that it's both. A mood stabilizer can be the same as an anti-seizure medication. Try one and see if it also helps the cycling. If the child is still acting out, you may need to add another medication. Epilepsy is also hereditary. My friend has it in spades in hers. Her mother had epilespy, she does, three of her sons do (one with grand mals) but NONE of them had erratic behaviors. So one doesn't mean the other. I wish you luck :smile:
  15. tiredmommy

    tiredmommy Site Moderator

    Here's what one doctor sees as the differences between ADHD and bipolar:

    By Dr. Charles Popper
    Both disorders share many characteristics: impulsivity, inattention, hyperactivity, physical energy, behavioral and emotional lability (behavior and emotions change frequently), frequent coexistence of conduct disorder and oppositional-defiant disorder, and learning problems. Motor restlessness during sleep may be seen in both (children who are bipolar are physically restless at night when "high or manic",though they may have little physical motion during sleep when "low or depressed"). Family histories in both conditions often include mood disorder. Psychostimulants or antidepressants can help in both disorders (that is, depending on the phase of the bipolar disorder). In view of the similarities, it is not surprising that the disorders are hard to tell apart.

    So what features can help in distinguishing these two disorders? Some distinctions are obvious.

    1. Destructiveness may be seen in both disorders but differs in origin. Children who are ADHD often break things carelessly while playing ("non-angry destructiveness"), whereas the major destructiveness of children who are bipolar is not a result of carelessness, but tends to occur in anger. Children who are bipolar may exhibit severe temper tantrums, during which they release manic quantities of physical and emotional energy, sometimes with violence and property destruction.

    2. The duration and intensity of angry outbursts and temper tantrums in the two disorders differs. Children who are ADHD usually calm down within 20-30 minutes, whereas children who are bipolar may continue to feel and act angry for over 30 minutes and even for 2-4 hours. The physical energy that a child with ADHD "puts out" during an outburst of anger could be mimicked by an adult who tries to "enact" the tantrum, whereas the energy generated by angry children who are bipolar could not be imitated by most adults without reaching exhaustion within a few minutes.

    3. The degree of "regression" during angry episodes is typically more severe for children who are bipolar. It is rare to see an angry child who is ADHD display disorganized thinking, language, and body position, all of which may be seen in angry bipolar children during a tantrum. Children who are bipolar may also lose memory of the tantrum.

    4. The "trigger" for temper tantrums is also different in these disorders. Children who are ADHD are typically triggered by sensory and affective overstimulation (transitions, insults), whereas children who are bipolar typically react to limit-setting (i.e., a parental "NO") and conflict with authority figures. A child who is bipolar will often actively seek this conflict with authority.

    5. The moods of children who have ADHD or bipolar disorder may change quickly, but children with ADHD do not generally show dysphoria (depression) as a predominant symptom. Irritability is particularly prominent in children who are bipolar, especially in the morning on arousal. Children with ADHD tend to arouse quickly and attain alertness within minutes, but children with mood disorders may show overly slow arousal (including several hours of irritability or dysphoria, fuzzy thinking or "cobwebs", and somatic complaints such as stomach aches and headaches) upon awakening in the morning.

    6. Sleep symptoms in children who are bipolar include severe nightmares (explicit gore, bodily mutilation). Additional information on the specific content of these dreams and why children do not freely reveal these dreams is available in another article by Charles Popper (Diagnostic Gore in Children's Nightmares). Children who are ADHD mainly show difficulty going to sleep, whereas children who are bipolar are more apt to have multiple awakenings each night or have fears of going to sleep (both of which may be related to the dream content described above).

    7. The ability to learn in children who are ADHD is often compromised by the coexistence of specific learning disabilities, whereas learning in children who are bipolar is more likely compromised by motivational problems. On the other hand, children who are bipolar are more able to use motivation to overcome inattention; they can stay tuned to an awesome TV show for long periods of time, but children who are ADHD (even if interested) may not stay involved, follow the plot or even stay in the room (especially during commercials).

    8. Children who are bipolar often show giftedness in certain cognitive functions, especially verbal and artistic skills (perhaps with verbal precocity and punning evident by age 2 to 3 years).

    9. In an interview room, children who are bipolar often demonstrate dysphoric, rejecting, or hostile responses during the first few seconds of meeting. Children who are ADHD, on the other hand, are more likely to be pleasant or at least non-hostile at first meeting, and if they are in a noisy location, they may immediately show symptoms of hyperactivity or impulsively. Children who are bipolar are also often "interview intolerant". They try to disrupt or get out of the interview, ask repeatedly when the interview will end, or even insult the interviewer. The child who is ADHD, on the other hand, may get frustrated, bored, or more impulsive, but usually without direct challenging the interview or the interviewer.

    10. The misbehavior of children who are ADHD is often accidental. If they crash into a wall (or a limit or an authority figure), it is often due to oblivious inattentiveness. The child who is bipolar, in the other hand, is more likely to crash into a wall with intent, for the sake of challenging its presence, Children who are bipolar are highly aware of "the wall" and are sensitive to ways of creating the biggest feeling of impact or challenge to it.

    11. The child who is ADHD may stumble into a fight, whereas the child who is bipolar will look for a fight and enjoy the power struggle. While a child who is ADHD may engage in self-endangering behavior without noticing the danger, the child who is bipolar enjoys the danger and seeks it out. The child who is bipolar is intentionally dare-devilish (yet needle phobia is quite prevalent). In general, the danger-seeking is grandiosity ("I'm invincible") in the child who is bipolar and inattentiveness in the child who is ADHD.

    12. In the child who is bipolar, danger-seeking grandiosity, energized giggling, and sexual hyperawareness may be seen early in the preschool years, and persist into adolescence and adulthood.

    13. The natural course of ADHD is chronic and continuous, but tends toward improvement. There may be periods of worsening, however, during situational or developmental stress, or if a coexisting conduct disorder worsens. Children with bipolar disorder may or may not show clear behavioral episodes or cycles, but they do tend to exhibit increasingly more severe or dramatic symptoms over the course of years, particularly as the child becomes larger and the impulsivity becomes more difficult to contain.

    14. Children with ADHD do not exhibit psychotic (thoughts and behavior reveal a loss of contact with reality) symptoms unless thy have coexisting psychotic depression, preschizophrenia, a drug-induced psychosis, a psychotic grief reaction. Children with bipolar disorder may, on the other hand, exhibit gross distortions in perceiving reality or in interpreting affective (emotional) events. They may even exhibit paranoid-like thinking or openly sadistic impulses.

    15. Lithium treatment generally improves bipolar disorder but has no or little effect on ADHD.

    The Coexistence of ADHD and Bipolar Disorder

    Children may have ADHD, bipolar disorder, or unipolar disorder (depression), and some children have a combination of ADHD and bipolar disorder or ADHD and unipolar disorder (depression). A child who has either bipolar disorder or unipolar disorder, but not ADHD, may be misdiagnosed ADHD, however, because both the bipolar and unipolar disorders may include symptoms of inattention, impulsivity, and even hyperactivity. There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.
  16. smallworld

    smallworld Moderator

    Loth, you've received some great advice. I have two children with mood disorders (depressive in nature but may in fact be bipolar disorder because they both react negatively to SSRIs taken without mood stabilizers). I would strongly encourage you to take Missy for an evaluation by a neuropsychologist in conjunction with an evaluation by a board-certified child psychiatrist (I assume you are already working with a good pediatric neurologist because of the seizure diagnosis). My son (difficult child 1) just went through his second neuropsychologist evaluation, and it gave us very helpful info that will guide both medication management and therapeutic interventions. He does have ADHD (primarily inattentive) with a significant mood overlay. While the neuropsychologist said ADHD is not his biggest problem (mood issues are), it is still helpful to know it is there because it does have an impact on academic functioning. My daughter (difficult child 2) is currently undergoing ADHD testing by a neuropsychologist because in 6th grade she is struggling academically for the first time and her mood issues are relatively stable. While both psychiatrists we work with suspect ADHD in our kids, they did not feel comfortable making the ADHD diagnosis without intensive neuropsychologist testing. The psychiatrists really are the only ones who can make mood dxes based on clinical observations and judgments over time (these psychiatrists see our kids weekly for psychotherapy), but their dxes can actually be bolstered by projective testing (administered by a psychologist). This is all my long way of saying that it's hard to make these sorts of differential dxes without the help of thorough evaluations and intensive testing.

    I also wanted to add that difficult child 2 has small lesions on her temporal lobes that her neurologist believes are contributing to mood instability. Regardless, the neurologist believes difficult child 2 is on the right treatment (anticonvulsants/mood stabilizers) because they treat both seizures (which in fact were not picked up on EEG) and mood disorders. That may in fact become the case for Missy because Trileptal treats both (although frequently it's used at higher doses for mood issues than for seizures).

    Hope you are able to find the right professionals to sort this out.