Childhood bipolar disorder vs. Aspergers Syndrome

[BusynMember]

This is such a good article comparing the two disorders, and they are so often mistaken for one another, that I thought I'd post it to the community. Our son, as most know, was misdiagnosed as having pediatric bipolar when he actually had high functioning autism. It's not uncommon for this to happen. Anyhow, here is the article!

https://web.archive.org/web/2012032...iatric-bipolar-versus-asperger-s-disorder.php

Pediatric bipolar disorder, or manic depression, is a mental illness that presents itself in patients as mood swings or mood cycling. Pediatric bipolar type one patients tend to experience episodes of mania alternating with periodic episodes of depression. Pediatric bipolar type two patients tend to experience episodes of depression interspersed with periodic episodes of mild mania. Depression symptoms include anger, extreme sadness, sleeping too much, and feelings of worthlessness. Manic symptoms include bursts of rage, extreme happiness, increased energy, hyperactivity, distractibility, sleeping too little, and obsessive behaviors.

Pediatric bipolar disorder is caused by a combination of neurological, biological, emotional, and environmental factors. Not all factors are present in every case, although most cases include biological and environmental factors. Little is known about the exact causes of pediatric bipolar disorder. However, advances are being made in this area.

Asperger's disorder can be described as a mild form of autism. Actually, asperger's disorder is a type of pervasive development disorder that can cause developmental issues, especially in the areas of communication and social development. Symptoms of asperger's disorder include problems with social skills, odd or repetitive behavior or habits, communication difficulties, and obsession with a limited range of interests.

The causes of asperger's disorder are not yet known. Studies show that asperger's disorder tends to run in families, meaning that it is hereditary. This fact shows that the underlying cause of asperger's disorder must be biological, meaning that it is either genetic or neurologically related.

Pediatric bipolar disorder can be misdiagnosed as asperger's disorder because pediatric bipolar disorder can present itself via symptoms such as obsessive compulsive behavior, odd habits, and bouts of rage. Patients of pediatric bipolar disorder and asperger's disorder both have symptoms that lead to lacking social development skills, educational issues, behavioral issues, and anger issues.

Pediatric bipolar can also be present in conjunction with asperger's disorder. Typically, this is the case. It is unknown, however, if the pediatric bipolar disorder is a result of the asperger's disorder, or if the same neurological issues that cause asperger's disorder are related to the chemical imbalances in the brain thought to be the cause of pediatric bipolar disorder. Answers to these questions will likely come to light as research in neurological, technological and psychiatric areas continue to progress.

Medication treatments for pediatric bipolar and asperger's disorders are quite similar. There are no medications for asperger's disorder; however, medications exist to treat the symptoms of asperger's disorder. Since the symptoms of asperger's disorder, such as depression, obsessive compulsive disorder, and anxiety, are the same symptoms often experienced with pediatric bipolar disorder, the medications used in both instances are the same.

Counseling treatments are also commonly used for both pediatric bipolar and asperger's disorders, used in conjunction with medication or alone. Most asperger's patients do not need medication. Counseling is required, however, to help the patient cope with their disability. Counseling treatments for pediatric bipolar disorder are considered necessary, with or without medication. These treatments can help the patient learn to recognize and correct irrational emotions or behavior.

 

[gcvmom]

Thanks for sharing this!

difficult child 2 was suggested to have Asperger's traits by his school psychiatric, expecially because of his social skills deficits and some of the obsessive/repetitive things he did as a preschooler/toddler (lining up cars or plastic animals, having a voracious interest in one or two subjects). But there are other aspects of him that do not fit the Aspie model. And he responds to medications the way you would expect someone with BiPolar (BP) would.

 

[Marguerite]

Medical science is so imprecise.

In reading the article, I see that "Depression symptoms include anger, extreme sadness, sleeping too much, and feelings of worthlessness. Manic symptoms include bursts of rage, extreme happiness, increased energy, hyperactivity, distractibility, sleeping too little, and obsessive behaviors."

But looking at this, anger is described as part of depression. And "bursts of rage" are described as part of mania. But they can also be simply reactive, a child who is given too much to handle, of stuff he is just not equipped to deal with. ie normal, for his 'whatever-is-wrong-with-him'. Not necessarily BiPolar (BP), which is the disease entity itself doing this.

It is such a delicate, fine distinction, but the outcome and treatment can be so very, very different.

Here in Australia, NOBDOY has mentioned bipolar to us, regarding any of our kids. And yet I'm sure if we had been living in the US, it would have been high on the list at least for difficult child 1 and easy child 2/difficult child 2. Maybe even easy child, because for her, living within such a dysfunctional family, plus experiences in her own life, have led to a lot of reactive problems.

I can only base my views on what I read because I have never lived in the US, but I do get the impression that BiPolar (BP) is diagnosed far too readily in the US; but perhaps not considered when it should be, in Australia.

The article goes on to say, "Patients of pediatric bipolar disorder and asperger's disorder both have symptoms that lead to lacking social development skills, educational issues, behavioral issues, and anger issues."

I take exception to this, I feel it is simplistic and a classic example of the misunderstanding I'm talking about - Asperger's people don't just have symptoms that lead to lacking social development skills, it is the very lack of social development skills directly, that are a diagnostic feature of Pervasive Developmental Disorder (PDD). Chicken or the egg. It's not causative, in Asperger's. it is in fact the condition itself doing this (ie manifestation), not causing this.

Iin other words, Aspies have social problems due to their innate inability Occupational Therapist (OT) learn social cues by osmosis, as other people do; but Aspies have rage/anger issues due to their reaction to a confusing environment, due to their inability to understand the social cues that come so readily to other people. However, those with bipoar will manifest rage and anger as part of the intense mood swings which are a hallmark of bipolar, rather than these being reactive, as in Asperger's.

I feel the author of this article is experienced primarily in bipolar and less so with Asperger's. Maybe they have encountered one or two cases of Asperger's, for every ten bipolar, because what the author describes seems to be confused as to causation, presentation and management.

Otherwise - a good article on a very important topic.

Marg

 

[BusynMember]

Marg, I sort of agree except I think bipolar and Aspergers are often intertwined. Your kids may have had a wrongful bipolar diagnosis. if you lived here, but there IS pediatric bipolar. I had it, and I'm not an Aspie. I wasn't rigid, I could transition, I didn't have GOOD social skills, but I wasn't at all shy about trying to make friends and I wasn't anywhere near as inappropriate as Aspies. I think that if it's never diagnosed in Australia, it's being missed or "children can't have bipolar" which I don't believe is true, having lived it myself. On the other hand, I do think bipolar is over-diagnosed here with Aspergers and other Pervasive Developmental Disorder (PDD)'s not even considered before bipolar diagnosis. are given out.
Marg, if your kids had bipolar, they would need medications or they couldn't functioin. I'm sure they are Aspies. Aspergers gets better. Bipolar gets worse and the moodswings get worse and the reasons for the moodswings are way different than for Aspergers. And, here in the US, these two disorders are often diagnosed as comorbid.
I've learned to be more cautious about accepting ANY diagnosis for my child that entails heavy medication because of my son's misdiagnosis. Psychiatrists are NOT good at diagnosing Pervasive Developmental Disorder (PDD)/Aspergers--they are looking for mental illnesses, not neurological differences. It's a big mess...lol.
I posted this article because it sheds a little light on both disorders. And I believe both disorders can and do exist in children. But I think the doctors have to be way careful. In the US, psychiatrists really hand out medications FAST. My son was on Ritalin by 3 years old. It was a medication he didn't even need, but ADHD is also in my opinion overdiagnosed/overmedicated. JMO

 

[everywoman]

I have often wondered if my difficult child is high functioning. He does display some of the symptoms of BiPolar (BP), but he has the Obsessive Compulsive Disorder (OCD) traits, the social cues, and the communication problems prevalent in Aspies. At 20, he is slowly progressing but is still behind his peers in social skills. He has not taken any medications in at least two years for BiPolar (BP), and although he does have some situational depression, he is not clinically depressed. He rages when he is overstimulated or anxious about social situations. Thinking back, most of his rages while younger happened because of social events---bd parties, holidays, sports. I had him observed by a team at school, but they did not see the signs. I never approached any medical diagnosis because by the time we got to a diagnosis. he was already a teen.

 

[TerryJ2]

Thank you!
I wish this type of article had been available yrs ago. Sigh.
We're all still learning.

 

[BusynMember]

My friend's son is a 30 year old Aspie. Because he threw himself in the road in front of cars at 15, he was diagnosed with bipolar, and put on Depakote. He went from a gorgeous young man to over 300 lbs, which he still is. He is brilliant and socially clueless and he never got any help for the Aspergers. Being as old as he was when he got the Aspie diagnosis., he refused to accept it and threw out his bipolar medications and has been doing better off of medications, but isn't really open to getting help. One day he took his disability check and flew to Costa Rica to marry a woman he'd met on the internet. One could say that sounds bipolar, but it's Aspie--life cluelessness. He wasn't manic at all, just not exercising good judgment. Of course, in Costa Rica (he taught himself fluent Spanish) he couldn't find a job and got no disability so he and his bride came home and they are still married. His obsession is religion and he is rigid about it. He is obviously not bipolar, but that was his diagnosis. I think a lot of undiagnosed Aspies walk around cluelessly, naive, willing and able to be victimized, many homeless or considered mentally slow (when many of them are brilliant--but also many can't hold a job). Also, because Aspies have such poor social skills, their strangeness makes people think they are "crazy." Including psychiatrists.
My friend is disgusted with all the wrong diagnoses her son got as she dragged him from one doctor to another for help. He was "ADHD" until he threw himself in the street so he was on stimulants too--a lot like MY son.
The health professionals really need to update their education. So many doctors get lazy and refuse to keep up with the latest. So many of our kids are wrongly diagnosed. It's really sad...jmo

 

[Marguerite]

I do agree that you can get both together, although I pity the clinician having to make that call. Not easy. I DO stand by the statement that medicine is a very inexact science.

And therein lies the trouble - clinicians really are cowards sometimes, once you get a certain (difficult to be certain) diagnosis, a lot of clinicians are like shep and will merely rubber-stamp the label and pass you on. That would be why your friend's son kept getting the BiPolar (BP) diagnosis over and over. Lucas too, I guess.

I think your suggested criterion (if it's BiPolar (BP) it will get worse, but respond to BiPolar (BP) treatment; whereas Aspies tend to adapt and seemingly improve, but without help will remain socailly clueless) is as good as anything, at least for now. And it IS possible (not desirable, but possible) to have diagnostic criteria using exclusion. CFIDS is a case in point - it still gets diagnosed by having certain characteristics, but in the exclusion of diagnosis with somethig else. Another example of imprecise diagnostics.

Yes, health professionals should keep up with their reading, but sometimes all the reading in the world won't protect you form making a wrong diagnosis - because the diagnostic criteria are still imprecise.

We had a wrong diagnosis with difficult child 1, until he was 14. That's eight years knowing something wasn't explained, but not knowing how to fix it. Eight years during a vital time in his education, when he got zero support. He's a very bright young man, but lacks the education to do what he really is capable of doing. Also lacks the confidence, hence his request to find a career in something that doesn't require any brain power. He is going to be VERY frustrated if he doesn't get more mental stimulation.

About the failure to recognise childhood BiPolar (BP) in Australia (my perception of this, that is) - we have an Aussie member on this site whose son really worries me, she's been trying to get some sort of understandable diagnosis and treatment for him and is really struggling, despite doing everything right. I am very angry with our health care system and our education system for its failure to help her. Very frustrating. PLus difficult child 3's friends at drama class - the range of problems is diverse, I suspect one young man with a diagnosis of Asperger's could have BiPolar (BP) as well - we see so many of them still not having a label that fits well, despite this group being more informed than most, more supported than most.

We have a good health care system Down Under, but it does have its drawbacks. Diagnosis of bipolar, where it's screaming at you that it's more than Asperger's, is one area that bugs me.

I know I'm critical of the article, MWM, but I do think it has its merit and the dscussion it promotes is DEFINITELY of value, we all need to be aware of the scope of problems in trying to pin down a diagnosis that fits.

marg

 

[Nomad]

One doctor thought our daughter had Aspergers and gave her the diagnosis.
I read up on it and saw many similarities.
But, one thing that stands out in my mind is that she wants to make friends and will often go out of her way to try to make them.
She does become obsessed at times...but it is not consistent and not long lasting. Two things that are consistent and long lasting...her impulsivity and mood swings.

 

[LittleDudesMom]

MWM,

thanks for posting this. It was an informative read.

Sharon

 

[liza]

This is such a good article comparing the two disorders, and they are so often mistaken for one another, that I thought I'd post it to the community. Our son, as most know, was misdiagnosed as having pediatric bipolar when he actually had high functioning autism. It's not uncommon for this to happen. Anyhow, here is the article!

https://web.archive.org/web/2012032...iatric-bipolar-versus-asperger-s-disorder.php

Hi there,

I know this thread was posted over 3 years ago, but the site says you're online and I'm hoping you can direct me to the write page as this one no longer works.
My son (7) was just diagnosed with bipolar disorder. I have been suspecting Aspergers for about a year now and a lot of it fits. I'm at my wits end, I can't afford a second opinion, as this evaluation was out of pocket and already cost me $2,000.
I've read tons of stories from parents whose children were mis-diagnosed.
What do I do??

 

[BusynMember]

It's an OLD one too...lolol Glad you liked it though

 

[buddy]

Other comparison sites:

http://www.bing.com/search?easy child=AMAZ&form=AMAZWB&setmkt=en-US&q=bipolar+vs+asperger's+syndrome

I'm sure you won't like this, but I would save for a other evaluation. Through a neuropsychologist or an Autism Clinic/center.

We here say trust your gut and at least you can research and use Autism Spectrum Disorders (ASD) methods to teach and parent no matter the diagnosis.

Who did the evaluation? ( not specifics, I mean the type of evaluation) I hope you start your own thread. It will be nice to get to know you.

 

[BusynMember]

I agree with Buddy. Get a neuropsychologist evaluation if you can. Autism Spectrum Disorders (ASD) is often misdiagnosed as both ADHD/ODD and bipolar, but they are different animals and the treatment is different.

 

[DDD]

Get a quality neuropsychologist evaluation so you will KNOW what issues you are confronting. At 17 it can be a number of things that perhaps you haven't even considered. Yeah, Iknow it is hard and it costs bucks. on the other hand, you need to to it.DDD

 

[InsaneCdn]

Welcome to the uphill road.
It took us... (counting in her head) something like 12 years to get an accurate diagnosis - and for us, it's not "one" diagnosis, its a range of things, but until we had ALL of them, we were getting nowhere, because... what works for one diagnosis, works against another, and difficult child has "both" kinds of dxes.

We paid a fair bit out of pocket, too - including having to get some testing done twice (multiple years apart)...

There is NO substitute for accurate diagnoses. Dxes drive interventions, accommodations, therapies, medications, parenting... without the dxes, everything else is a shot in the dark.