Bipolar disorder and ADHD, or attention deficit hyperactivity disorder, are two conditions that are increasingly being diagnosed in American children and teens, often together. And interestingly, in children and teens, there are some similarities in the symptoms of the two conditions. But how can a doctor know for sure if the child has bipolar disorder or ADHD? Also, how does the treatment for these two conditions differ?
Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That's especially true for teenagers in whom irritability and moodiness commonly co-exist as part of a normal adolescence. A preteen or teenager with mood swings may be going through a difficult but normal developmental stage. Or he or she may be suffering from bipolar disorder with periodic mood changes that shift from depression to mania.
In addition, symptoms of ADHD often mimic symptoms of bipolar disorder. With ADHD, a child or teen may have rapid or impulsive speech, physical restlessness, trouble focusing, irritability, and, sometimes, defiant or oppositional behavior. Children or teens with bipolar disorder often have similar behaviors.
According to one study, today's children and teens are 40 times more likely to be diagnosed with bipolar disorder than they were 10 years ago. The reason isn't entirely clear. The higher rate of diagnosis could be the result of more awareness on the part of health professionals. There are those, though, who say it could be a result of a lack of parenting that leads to behaviors that are tagged as mental illness.
Some studies have shown that children and teens diagnosed with bipolar disorder are more likely than adults to also be diagnosed with ADHD.
What is childhood bipolar disorder?
Bipolar disorder is a persistent and difficult mental illness. When it occurs in childhood or adolescence, it can completely disrupt the life of the family. Bipolar disorder that's undiagnosed, misdiagnosed, or poorly treated is associated with:
•Increased rates of suicide attempts and completions
•Poorer academic performance
•Increased rates of substance abuse
In adults, bipolar disorder is marked by mood changes that go from depression to mania. Adult mania is characterized by decreased need for sleep, rapid speech, euphoria, grandiosity, irritability, racing thoughts, and frenetic activity. The definition of mania is not so clear for bipolar disorder in childhood. Some experts say that being irritable, cranky, and negative may be the only signs of mania in children with bipolar disorder. And other experts argue that childhood bipolar disorder may not even be the same disease as adult bipolar disorder.
What is clear, though, is that bipolar disorder is an increasingly common diagnosis in children -- including children of preschool age.
What are the warning signs of bipolar disorder in children and teens?
With bipolar disorder, there are both manic symptoms and depressive symptoms. If your child or teenager has five or more symptoms that persist for at least a week, it is important to seek professional help. With medications and/or psychotherapy, mental health professionals can help stabilize your child's moods. Treatment can also diminish or eliminate the depressed or manic thoughts and behaviors.
Manic symptoms include:
•Severe changes in mood, either extremely irritable or overly silly and elated
•Overly-inflated self-esteem, grandiosity
•Decreased need for sleep, ability to go with very little or no sleep for days without tiring
•Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted
•Distractibility, attention moves constantly from one thing to the next
•Hypersexuality, increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
•Increased goal-directed activity or physical agitation
•Disregard of risk, excessive involvement in risky behaviors or activities
Depressive symptoms include:
•Persistent sad or irritable mood
•Loss of interest in activities once enjoyed
•Significant change in appetite or body weight
•Difficulty sleeping or oversleeping
•Physical agitation or slowing
•Loss of energy
•Feelings of worthlessness or inappropriate guilt
•Recurrent thoughts of death or suicide
How is ADHD different from bipolar disorder?
Bipolar disorder is primarily a mood disorder. ADHD affects attention and behavior; it causes symptoms of inattention, hyperactivity, and impulsivity. While ADHD is chronic, bipolar disorder is usually episodic, with periods of normal mood interspersed with depression, mania, or hypomania.
How is bipolar disorder treated?
Doctors usually treat bipolar disorder in young people the same way they treat it in adults. They use medications called mood stabilizers, which include anticonvulsants such as Depakote (valproate), Lamicta (lamotrigine), Tegretol (carbamazepine), Trileptal (oxcarbazepine), and lithium. Children are just as likely as adults to be treated with antipsychotic drugs, usually, the newer "atypical" antipsychotics. Sometimes, children receive a combination of drugs such as a mood stabilizer and an antidepressant.
How is ADHD treated?
Treatment for ADHD includes medications and/or behavioral therapy. ADHD medications can be psychostimulants such as Adderall, Concerta, Ritalin,and Vyvanse, or nonstimulant medications such as Intuniv (guanfacine) or Strattera (atomoxetine). Antidepressants, such as Wellbutrin (bupropion), are also used.
How can I make sure my child receives a proper diagnosis and treatment?
If your doctor suspects your child has bipolar disorder or ADHD, here's what you can do:
•Ask how the diagnosis was made.
•Make sure the doctor talked with the child's teachers or had written reports from teachers.
•Be sure the doctor evaluates the child over a period of time, not just from one visit.
•Review all of the information that went into making the diagnosis of ADHD or bipolar disorder.
•Before deciding on treatment, consult an expert in child and adolescent psychiatry for a second opinion.
•Make sure the doctor sees the child frequently after the diagnosis is made to check the medication for effectiveness and side effects.