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.
