Thursday, April 8, 2010

Bipolar or ADHD?

Today, I dropped by Tristan's school to talk to the nurse about his new medication routine. To my surprise, the nurse had a son, now 19, who had been misdiagnosed as ADHD and struggled for most of his late childhood and adolescence before being diagnosed as bipolar. She said the difference after mood stabilizers was "night and day."

Her struggle and heartbreak sounded eerily similar to mine.

In the past few years, there has been a backlash against ADHD/ADD as a diagnosis in children. I've had doctors tell me that they're finding that more children are being (possibly) misdiagnosed as bipolar because the symptoms are so similar to those of ADHD/ADD. Bipolar is now the "in" diagnosis to get.

I don't think this is occurring because of a trend; I think doctors are getting better at diagnosing bipolar disorder. It was once thought that bipolar was an "adult" disease.

Here's a list of bipolar symptoms in children:
*silliness, goofiness, giddiness
*fidgetiness/ restlessness
*rages/explosive temper tantrums
*racing thoughts
*aggressive behavior
*oppositional behavior
*isolation from peers
*learning disabilities
*compulsive behaviors
*excessive daydreaming
*lack of organization
*destruction of property
*rapid or pressured speech

Symptoms of ADD/ADHD:
*talks excessively
*rages/explosive temper tantrums (typically borne out of frustration or overstimulation)
*lack of organization
*aggressive behavior
*rapid, sometimes inappropriate speech
*isolation from peers

It's easy to see why bipolar disorder can be confused with ADD/ADHD. The main difference, to me, is that the ADD/ADHD symptoms are constant, whereas the bipolar waxes and wanes.

The treatment for ADD/ADHD (stimulants) can often exacerbate bipolar symptoms. Of course, many doctors and parents may come to the conclusion that the medication isn't working and will run the gamut of stimulant medications. It is working, of course, just not the way it was expected to. Bipolar medication in ADD/ADHD patients typically are sedating, which may appear to help the ADD/ADHD symptoms.

Bipolar disorder and ADD/ADHD can coexist. If they do coexist, it's important to treat the bipolar symptoms first so as not to have the symptoms become out of control.

I think that it will become more and more common for children to have diagnoses of bipolar disorder as more is learned about this illness. Whether that's a good thing or not, I couldn't say. I don't think it's right to diagnose children with bipolar just to put a name on a symptom.

There's been such a backlash against Ritalin and ADHD and I have encountered many children that have struggled with school and hyperactivity. When asking their parents about it, many times I've been told "He's just a little active, that's all. I'm not throwing medication at a kid that's just a little more active." While I completely agree with that ideal, if a child is genuinely struggling in school and can be helped by medication, why not help that child to their full potential?

My main issue with this is that I wonder; can't we find a medium ground? There must be a way to distinguish true bipolar diagnoses from true ADHD diagnoses. Doctors need to be trained to distinguish the difference to the best benefit of the child. I think that getting better at diagnosing correctly can help make a child's life richer and enable them to have more common experiences among children, to live a more "normal" life, if you will.

I think of the past few years with Tristan and how he's been volleyballed between diagnoses. All that time wasted while doctors had verbal fisticuffs over what to call his symptoms. We certainly could have filled that time with better things and I know there are other parents and children out there having the same fight.

Edit: Tristan took the new dose of medication at school and had no problems doing his homework today. Hurray!

1 comment:

  1. Great news with Tristan's homework! I was, at one time, misdiagnosed with ADHD. I think the biggest danger there is that if you give a person with ADHD a mood stabilizer, it just won't do anything. But if you give a person with bipolar disorder a stimulant, it can really trigger a bad manic/hypomanic episode and have some serious repurcussions. The last thing I needed was an "activating" medication and it did spiral me into a hypomanic episode, at which point I immediately switched psychiatrists (my husband made the switch for me--I wasn't in good shape). I really wish doctors would take more care with anyone, child or adult, who has a rather nebulous diagnosis, to be careful with activating psychotropics. We learned the hard way to look for symptoms of a manic/hypomanic episode upon introduction of the medication.

    I do believe bipolar disorder has become somewhat of a trendy diagnosis, particularly in adults. Especially the more subtle Bipolar II which I have. But it's absolutely the right diagnosis for a lot of people, a lot of children, and I'm glad that doctors are finally open to the possibility. Just a decade ago it was thought that bipolar was totally rare in children, and yet the number of children helped by mood stabilizers and acute intervention for bipolar-specific symptoms belies the diagnosis.

    It can be a tiring battle, this chasing of the treatment. And childrens' bodies change so rapidly, what works one day may need an adjustment just a few months later. I'm so glad to hear that Tristan has stopped experiencing the acute symptoms he'd had.