Bipolar Disorder

[Malika]

Just to find out (because I don't actually know!), I just did a little internet research on bipolar disorder in children. And apparently the symptoms are exactly like those of ADHD! The article I read did also say that children have intense emotional outbursts and uncontrollable, violent rages, comparable to emotional seizures. That would not be true of J, who has intense emotional outbursts but I couldn't call them uncontrollable or violent or like a seizure. But it is interesting. Also found a site that said there was a great deal of controversy about diagnosing small children with BiPolar (BP) and giving them anti-psychotic medicine and that it was largely an American phenomenon; British doctors do not diagnose it before the teen years. So, not straightforward...

 

[BusynMember]

I noticed. Seems that other places seem to call everything ADHD until the kids are older. Some diagnose autistic spectrum disorders though. I'm not sure you can accurately know what bipolar is in children. My son was misdiagnosed with it and I'm sorry we ever heard the word...and the medications. However, I also think certain behaviors are a foreshadowing of things to come, some which may be bipolar disorder.
I think a lot of bipolar diagnosis. are actually regular depression/mood disorders in kids. Although other countries may not diagnose them in children, I had that as a child without any doubt and it continued and got worse as I grew older. But actual bipolar? I didn't have that...I still don't have typical bipolar. I wonder how many children diagnosed with bipolar will actually end up with clearcut bipolar when they are adults.
On the other hand, I do think in certain other countries, Autism Spectrum Disorders (ASD) is misdiagnosed as ADHD and Ritalin is handed out as a catchall for everything. I'm not quite convinced ADHD ever stands alone.
So much to think about when there are no blood tests.

 

[InsaneCdn]

I'm not quite convinced ADHD ever stands alone.

I've got an almost-easy child with ADD - inattentive type. Yes, it can stand alone. Literally - it is the only source and the only logical explanation for her "issues". Without medications, her brain "slows down" and she's pretty much lost in some other world. medications - standard Ritalin-family stuff - and she's pulling top marks in school, excelling in music, active in sports... but medications don't solve "ADD-think" for anybody - the tendency to see the alternative meanings in things!

BUT... Given that 50% of all kids with ADHD also have Developmental Coordination Disorder (DCD)... and there is proven co-morbidity between ADHD and a range of other issues including all of the classical learning disabilities... obviously, well over half of all ADHD people have other issues too.

Having said that... ADHD is one of the most mis-diagnosed dxes out there. There are probably as many kids who should have the diagnosis and don't get it, as there are kids who are diagnosed as ADHD and should really have another diagnosis - the most common one on that front that I know of, is stuff related to Autism Spectrum Disorders (ASD).

My first psychiatrist who did my diagnosis with ADHD (PhD prof working out of children's hospital.) said that anyone who was not responsive to stims given for an ADHD diagnosis, probably doesn't have ADHD.... In his opinion, ADHD always responds positively to stims; but sometimes the side-effects mean they need to go to a non-stimulant medication. Stims making the kid worse? Probably NOT a true ADHD diagnosis.

 

[BusynMember]

My daughter has an ADD diagnosis too, and she has no behavioral problems or even the classic impulsive acting out or inability to calm herself down. But she does have A LOT of trouble paying attention and she has organizational issues. My guess is that she also has learning disabilities, which is common with ADHD.
I think many ADHD kids also struggle with mood disorders. It seems that all the disorders seem to go round and round and somehow touch one another.
My daughter is doing well on low dose stimulants. Last year she struggled much harder in school than she is now. And she is reporting no side effects except lack of appetite (which doesn't bother her, since she's a teen girl...lol). She is, however, on a lower dose.
I do struggle with wondering if bipolar is a valid diagnosis for kids. In spite of myself having had serious depression as a child, along with suicidal thoughts, I don't believe it was bipolar. It WAS the early beginning of my mood disorder not otherwise specified, which is different from bipolar. Once called bipolar II, it is really just a struggle with depression and a few very slight hypo-manic episodes that did not take me to psychosis. I never hallucinated while on my mild highs. I functioned just fine. I am not convinced that they can identify who is going to develop bipolar when they get older and am not comfortable with the diagnosis. since they wrongly handed it out to my son. I'd like to see if there are any studies showing that kids dxd. with early onset bipolar continue onto have clearcut bipolar disorder as adults. in my opinion only, and I'm hardly an expert, they seem like symptoms more likely to mean a personality disorder will develop...but, hey, I don't know nuttin'...

 

[HaoZi]

Mine has a bi-polar diagnosis. This may or may not be correct, but it is the only way the insurance will cover the medications that do help her.

 

[keista]

I've seen ADHD stand alone. As a matter of fact two of my girls' friends have this diagnosis. in my opinion they are typical ADHD presentations. IOW they are easily distracted and prone to hyperactivity. They are great kids who just need constant redirection. Over the years, most of the kids I've met with ADHD presented similarly. Indeed some might label them as ODD because it seems as if they refuse to comply with an adult's request to sit still, etc. But all they do is not comply because they can't. They've never gone into rages because and adult told them to sit still or told them what to do. I firmly believe the combined ADHD/ODD dxes are something else.

Malika, can you post links to the symptom lists you found? When I search symptoms for the two, there is some overlap, but some very obvious differences. If on the other hand, you are reading parent stories, then they certainly can be the same since kids are mis-diagnosed ALL the time.

 

[Malika]

I typed "bipolar symptoms in children" into google and it came up with this article.

http://www.healthyplace.com/bipolar...n-children-mimic-other-psychiatric-disorders/

Reading this, it makes it fairly clear to me J would not be suspected of having Borderline (BPD). The trouble is, perhaps, when one starts looking for diagnoses everywhere? A friend of mine's son, for example, is what one would call very spirited. He's 8 now, and has calmed down a lot since I first knew him when he was 2, when he was very hyperactive, oppositional, etc - but also very sweet. He is still rather rude to his parents and gets very upset on occasion, but is basically a good kid who although not academic, gets on okay in school. There has never been any question that he "suffers" from anything but if one wanted to, one could maintain that he had this or that disorder.... If it were not for J's hyperactivity, neither I nor anyone else would have started thinking there was something "wrong" with him - he would just be seen as a difficult or turbulent child, I think. But there is the hyperactivity and it does seem to point to something else... ADHD with probably ODD seems to fit him, there's no reason to suppose anything else is going on. And I don't say that because I'm denying anything or making some judgement about other conditions
Keista - when you say you firmly believe that ADHD/ODD diagnoses are something else, do you mean you believe they are actually misdiagnoses for other conditions? Do you not think that ADHD is often co-morbid, as I believe they say, with other conditions, including ODD? Which, although many people here say does not "exist" by itself, does actually make sense to me as a separate diagnosis? But even then, when you read about ADHD, many people talk about the impulsivity leading to aggression in some cases, without bringing in the notion of ODD so even then it is not straightforward. I'm in no position of expertise, having met or known few other ADHD children, but I have read an awful lot about it now...

 

[DammitJanet]

Bipolar and ADHD are two totally different beings. Its like horses and zebras, you can hear hoof beats with both but when you turn around, they are definitely different animals.

I have both bipolar and ADHD in my family. Jamie was/is the most clearly typical ADHD child on the planet. He was extremely hyper as a kid and also was had such a hard time with attention in school. If you have ever heard those sayings about things where the kid is talking perfectly normal and then in mid sentence they break out in oh look, a pretty butterfly!, that was Jamie. He couldnt pay attention for anything without medication. I dont think he watched a complete TV show until he was in his late teens. LOL. We owned all the current video systems but the only time he actually played them for any period of time was on rainy days. And he hated rainy days. He was also very impulsive but it wasnt in any sort of mean or naughty way. Just OOPS! Didnt think that through.

Cory, on the other hand, could act just has hyper and have just as severe in attention issues as a child but his impulsive issues were more of a thought out nature. If he threw a ball, it was on purpose because he wanted and intended to have it break something. Jamie could toss a ball and have the same result but he just never thought about the fact that if you tossed a ball in the air in the house that the ceiling fan might catch it and hit it and send it flying. Cory thought it through and deliberately tossed the ball down the hall intending to break a window.

Also totally different medications work though when very young, Cory could take the stimulants to help with the hyperactivity and the attentional issues but when he hit puberty they started causing major problems.

 

[InsaneCdn]

Janet -
Thanks for the practical description of the difference between ADHD and BiPolar (BP).
You're right about ADHD being an honest "not thinking" problem... rather than "deliberate" damage.

Our difficult child? definitely ADHD. But the deliberate damage stuff... was the result of secondary mental health issues, not the ADHD.

 

[Malika]

Hi Insane. I think it's a bit difficult, personally, to draw a clear and unambiguous line between what is "deliberate" and what is not "deliberate" when it comes to impulses. J will say horrible things to me when his will is thwarted - it is more the exception than the rule these days, but it still happens. Does he do this "deliberately"? What does that really mean? He's basically a sweet-natured kid, and I don't say that because I am biased or can't see him other than with rose-coloured glasses; lots of other people have made the same comment about him. So do I think he "deliberately" wants to hurt or antagonise me? I don't see it that way round, really. I see that he is extremely frustrated and he doesn't have the skill or ability to deal with it other than by lashing out. I think his wanting to hurt is probably not in the picture - a few minutes later he will be his usual affectionate self...
Do you see what I mean? It's very confusing all this...

 

[HaoZi]

One thing the psychologist we liked told us about diagnosis'ing pediatric BiPolar (BP) is that to many psychiatrist's the natural buoyancy of many kids can be easily mistaken for a manic phase when the kid is actually unipolar (this is what he thinks is really going on with Kiddo and said not to rock the boat about if the medications are helping because the insurance won't cover them under the unipolar diagnosis, and no, he's not the psychiatrist she sees regularly to get her medications, he's the one we went to for testing since none of the psychiatrists could be bothered to do it).

 

[DammitJanet]

Malika, that sounds more than ADHD to me. Honestly. Cory was the sweetest kid on the planet and he still is. I had cops who were arresting him and putting him in handcuffs joking around with him and telling me at the same time that they couldnt believe what a great kid he was...except for...blah blah blah. Later in the week if he saw those same cops, he would be great with them and give them hugs and you would think they were best of friends. But yet at the same time he could throw a fit with the best of them.

I do think you need to find some sort of real structure with him because these kids do much better with a high level of structure in their lives. They arent good with a free flowing system. It confuses them. They need those firm boundaries of everything being cut and dried.

 

[Malika]

Malika, that sounds more than ADHD to me.

Yes. It's ADHD with ODD symptoms. I have no reason at this stage to think that he is bipolar. From what I have read online, he does not fit the bill. Why go chasing worry, I tell myself...

 

[BusynMember]

I have the same problem with "can" or "can't." As one with problems myself as a child, I did not control myself. It was a combination of everything building up inside of me and an inability to control myself. Does that mean I couldn't? Even I can't answer that question. Certainly a large part of me couldn't. And that continued into adulthood.
It took the right medications and great therapy for me to be able to reflect and control myself. I did feel horrible after an eruption. It didn't go away in a few minutes or even an hour. I would ruminate over how horrible I was and even feel suicidal. Yet, I never did understand if I could have stopped myself from what I said or did or if it was beyond my control.
In my case, I feel that medication was mandatory...I tried many times to go without. I do not feel that every case requires medication and I think psychiatrists often way overmedicte...and I think that is worse than no medications at all.

 

[keista]

Keista - when you say you firmly believe that ADHD/ODD diagnoses are something else, do you mean you believe they are actually misdiagnoses for other conditions? Do you not think that ADHD is often co-morbid, as I believe they say, with other conditions, including ODD? Which, although many people here say does not "exist" by itself, does actually make sense to me as a separate diagnosis? But even then, when you read about ADHD, many people talk about the impulsivity leading to aggression in some cases, without bringing in the notion of ODD so even then it is not straightforward. I'm in no position of expertise, having met or known few other ADHD children, but I have read an awful lot about it now...

When I see an ADHD/ODD diagnosis I usually believe it is something else simply because I see symptoms/behaviors being described that do not fit into wither diagnosis. I do believe that at least superficially that ADHD does exist as an observable behavior pattern. It may also truly exist as a co-morbid disorder. ODD certainly can appear as a valid diagnosis as well. For example. An ADHD child is told to stay seated. He does not. THAT appears to be defiance. However, if the child truly has ADHD, he can NOT stay seated. So, is it truly defiance? The problem with that ODD is that it can used to describe behaviors of virtually any other disorder "our" kids suffer from. Even the DSM says that other stuff MUST be ruled out first and/or treated, but this causes a catch 22, because it's really hard to find valid dxes in the DSM for kids who display aggression, suicidal thoughts and other negative behavior without stretching the diagnostic criteria, so doctors settle on the things they CAN identify, but there are still "leftover" symptoms that don't fit into any given diagnosis. in my opinion they created ODD to help fill that gap of missing dxes.

The latest one being discussed is TDD (Temper Dysregulation Disorder) Which in my opinion better describes these explosive kids and allows for extreme moodiness, but it still doesn't cover "our" kids that are relatively happy in between. http://dyslexiauntied.blogspot.com/2010/03/temper-dysregulation-syndrome-tdd.html

many people talk about the impulsivity leading to aggression in some cases,

This is in conversation and discussion. This could be situations where ADHD has been misdiagnosed. Aggression is not a listed symptom of ADHD http://www.webmd.com/add-adhd/guide/adhd-symptoms?page=2

The problem with discussing something like bipolar, especially in kids, is that it is also a spectrum disorder. Cyclothemia is the "mildest" form, and can more easily be identified in children, but gets all but forgotten. http://www.mayoclinic.org/diseases-conditions/bipolar-disorder/basics/symptoms/con-20027544

Anyway, my opinion of ADHD/ODD hasn't changed. I have no doubt in my mind, that such a combined diagnosis can and does exist, but I have never seen it in real life, and I haven't seen it on this forum. There always seem to be "leftover" symptoms that aren't clearly defined by either diagnosis.

 

[Malika]

Hello dear Keista. Thank you for that information. Your slogan reads "no medications are better than the wrong medications". Maybe "no diagnosis is better than the wrong diagnosis"? I am not looking to collect diagnoses at the moment. Things are enough in hand that things will reveal themselves in due course. Other than that, I am just taking it day by day with a child who is both extremely challenging by moments and extremely sweet and affectionate the rest of the time - it's a maybe 20/80 split... Sufficient unto the day, I reckon

 

[Marcie Mac]

I would only wish that Danny would have had a bi-polar diagnosis when he was younger instead of older. Seemed the ADHD medications worked ok for a while, and each change would ramp him up, and around pubety, then all h*ll broke loose. Kept taking him back to the doctor and telling them this is NOT ADHD - I have stand alone ADHD and I never acted like that - only similarity was impulse control. Wasn't till he was 14 I took him to the psychiatric doctor and got the right diagnosis. All those wasted years, and misery for him in school and once they are labeled "the bad kid" there is no putting that back in the can as far as the school/justice system went. Back then I found this forum, and wonderful parents who set me a bit in the right direction.

Marcie

 

[compassion]

I get lots of info and support from the child and adolescent foundation

Mania is different than ADD. My daughter has Bipolar 1. When the mania was treated with antipsycotic and mood stabilizer,then her focus issues could be dealt with. Strateera did help a lot with that but first the mania had to be treated.

 

[Malika]

It's very good if children with bipolar can be identified and treated. If a child doesn't have bipolar, I wouldn't want that diagnosis to be made (like any other incorrect diagnosis). Diagnosing anything in very young children is rightly subject to great caution.

 

[keista]

LOL Malika, my signature pretty much says that as well. "I don't care what label you put on my child as long as he/she gets the help that they need!"

I am not so much fixated on labels, but the WRONG label, like the WRONG medications, can do more harm than good. I don't want that for any child or parent. I'm having a similar struggle with DD1 at the moment. She just doesn't fit the criteria for anything. At least she didn't used to back when she was 8. Now she's 10 and off of medications, and I am noticing symptoms in a new light, but again, still not really fitting into any diagnosis or even multiple dxes.