Differentiating irritability ADHD vs BiPolar (BP)


New Member
Did anyone look at the recent CABF newletter? There is a review of a recent talk:

"Dual Diagnosis
ADHD and Bipolar Across the Lifespan
By Bryna Hebert, CABF Member

At a recent seminar, Harvard expert Dr. Timothy E. Wilens spoke about the persistance of bipolar over the lifespan and its high rate of co-occurrance with other disorders.....
Dr. Wilens also spent a considerable amount of time discussing irritability. He referred to a paper by Eric Mick, Sc. D., published in Biological Psychiatry 2005; 58:576-582, that delineates the different faces of irritability. Mick describes the irritable child with ADHD as one who is easily frustrated and has a quick temper, but gets over it quickly as well. The child with Oppositional Defiance Disorder has a very quick, hot temper and is oppositional. Irritability that is attributed to depression can best be characterized as cranky, negativistic, and more persistent. Irritability caused by mania, as with Juvenile Borderline (BPD), is explosive and violent: rage that persists for thirty minutes or longer. While it may be possible to distinguish between different types of irritability, Dr. Wilens acknowledged that this is a symptom that many child and adolescent psychiatrists prefer not to use to diagnose something as serious as Borderline (BPD)."

This caught my eye, because irritability is more of constant feature of my kid's lives than just about anything else. We have yet to find a medication that really helps my youngest (beyond a small dose of Abilify that we can't push any higher), whereas Lamictal has been a godsend for my oldest and his irritability.

Has anyone read the Mick article? Wondering if it was insightful for those of us in the trenches....


Mom? What's a difficult child?
This is one of the things that caused the nuero-psychiatric and original psychiatrist to have the initial feeling that there might be a mood disorder going on... Both felt most likely Early Onset Bi-Polar (EOBP)

She had incredible long violent rages as well as cranky and negative... she has irritability like described for the depression and the mania....

I was just on the site... I will go back on and read the newsletter.


My difficult child has the persistent, negative irritability. And she also has the violent, explosive, long-running rage. I'm actually surprised that none of my neighbors have called the police just to make sure everything is ok. She'll be in the house with all windows and doors closed and I can hear her plain as day at the mailbox on the curb when she's in one of her rages.


trying to survive....
My difficult child rages are pretty short lived--which could be considered adhd--but he is on medication so I wonder what it would be like without the medications...now he looks adhd--


Well-Known Member

The best way to tell, in my opinion, is if mood stabilizers and antipsychotics help and stimulants don't help or make things even worse. I have bipolar, and it does get worse with age, unlike ADHD, unless it is treated properly, so that is also a symptom. Impulsivity and hypernness is common in both. Childhood mania can look like ADHD, but stims and Straterra would make it worse, not better. Too bad there aren't any blood tests.


Interesting. You know, before I joined this group I never knew of anyone who had a kid who raged. My difficult child 1 started raging at about age 3 and then quit after attending her Residential Treatment Center (RTC) at age 16. She had gotten better before the Residential Treatment Center (RTC) but we still saw some. It seemed like you could see them coming on--she would get agitated and maybe she would start laughing in a manic way. Nothing we did while she was having one seemed to help, they seemed to have to play themselves out. She would finally start sobbing and then you would know it was coming to an end. I never did find any professional who could tell me why she did this. She does seem to have outgrown it or somehow manages to control it now. Any ideas?


Active Member
My difficult child was very irritable before Lamictal. As others have stated, he now appears very ADHD, VERY high on the H. We are still titrating up on the Lamictal, so maybe we will see more improvement.

Straight stims made things worse. He was so fragile emotionally, he cried one morning for 1.5 hours because he thought I was yelling at him. ( I used a firm tone of voice) He had to change his shirt as it was soaked with tears. No more stims alone for us.


New Member
see this is where i think my difficult child had adhd also as he has the long violent(his BiPolar (BP)) and the quick frustration. i just know that one of the reasons we can't pin down his triggers for meltdowns is that sometimes they are just different types of meltdowns. now trying to get the school to recognize this. . .!