Is It Bipolar Disorder or AD/HD?

The

Bipolar Disorder-AD/HD Controversy

Carol

E. Watkins, M.D.

 

There is a great deal

of controversy about the diagnosis of Bipolar Disorder in Childhood.

Sometimes it can be difficult to differentiate AD/HD, irritable depression

and Bipolar Disorder in children.

Books such as The

Bipolar Child have received  popular attention and raised public

consciousness about difficult to treat children with  explosiveness and

rapid mood swings. While the book gives excellent descriptions of individual

children, it is not a research-based document. We have seen an increase in

the use of antipsychotics (such as risperidone and haloperidol )and mood

stabilizers (such as valproate and lithium) in younger children.  

Joseph Biedermann’s

group at Harvard has published extensively about AD/HD and childhood Bipolar

Disorder. They feel that it can coexist with AD/HD and can often be reliably

diagnosed in childhood. Other researchers such as Peter Jensen (coordinator

of the MTA Study) and Gabrielle Carlson of NIMH are more cautious about

diagnosing childhood bipolar disorder. They feel that we do not yet have

enough evidence to show that children with rapid mood shifts or

explosiveness will grow up to have the same illness as adults with Bipolar

Disorder.   

When Bipolar Disorder

starts in childhood, it tends to be more severe and the mood swings are more

rapid. At times the mania and the depression may even be mixed. The “up”

swings are often explosive or irritable. There may be fewer or no stable

moods between swings.  We look for severe mood shifts, pressured speech,

episodic dangerously impulsive behavior, episodes of blind rage, thought

disorder, paranoia or hallucinations.  We also look for a family history of

Bipolar Disorder or severe mood instability.  

Given the uncertainty

among experts, how do we treat difficult children with inattention, mood

lability, explosiveness and rage? These children need a careful diagnostic

evaluation and close follow up. Even when things appear stable, it is not a

good idea to wait 4-6 months between clinical visits. Since these conditions

can evolve over time, repeated evaluations may be necessary.  Remember that

medication response does not clinch a diagnosis.  If we try to make a hard

and fast diagnosis of Bipolar Disorder too early, we may have a lot of false

positives. If a diagnosis of Bipolar Disorder becomes obvious when the child

is 15, it does not mean that the earlier evaluators missed an obvious

diagnosis.  

If a child or

adolescent does appear to have Bipolar Disorder co-existing with AD/HD, we

may use mood stabilizers, antipsychotics, benzodiazepines and other

medications. These medications can be a great help to certain children but

they do have potential side effects. The family and the entire treatment

team need to be involved in an overall plan. The use of stimulants in

children with both AD/HD and Bipolar Disorder is controversial. I use them,

but will first cover the individual with a mood stabilizer or an

antipsychotic. These children and adolescents are at particular risk for

substance abuse. It can be dangerous to combine illegal drugs with mood

stabilizers. Start drug abuse education early!! 

 


Northern

County Psychiatric Associates

Our practice has experience in the treatment of Depression, Attention

Deficit Disorder (ADD or ADHD), Separation Anxiety Disorder, and other

psychiatric conditions. We are located in Northern Baltimore County and

serve the Baltimore County, Carroll County and Harford County areas in

Maryland. Since we are near the Pennsylvania border, we also serve the York

County area. Our services include psychotherapy,

psychiatric evaluations, medication management, and family therapy. We treat

children, adults, and the elderly. Visit our web site https://www.baltimorepsych.com

or http://www.ncpamd.com 

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 Northern County Psychiatric

Associates 

Our practice has experience in the treatment of Attention

Deficit disorder

(ADD or ADHD), Depression, Separation Anxiety Disorder, Obsessive-Compulsive

Disorder, and other

psychiatric conditions. We are located in Northern Baltimore County and serve the

Baltimore County, Carroll County and Harford County areas in Maryland. Since we are near

the Pennsylvania border, we also serve the York County area.   Our

services include psychotherapy, psychiatric evaluations, medication management, and

family therapy. We treat children, adults, and the elderly.

We also maintain a list of informative web sites on mental health

topics, such as Attention Deficit Disorder, Parenting and Support Groups.


Northern County Psychiatric Associates
Niacin Pills to Pass a Drug Test

Lutherville and Monkton

Baltimore County, Maryland

Phone: 410-329-2028

Web Site https://www.baltimorepsych.com

http://www.ncpamd.com 

Copyright 2000

Contact Us:

Telephone:410-329-2028

Fax: 410-343-1272

Postal address: We have two locations in Baltimore County

      Monkton Office16829 York Road/PO

Box 544/Monkton, MD 21111

      Lutherville Office: 2360 West

Joppa Road Suite 223/ Lutherville, MD

Email: [email protected]

Please use telephone for appointments or medical questions.

Carol Watkins, M.D.

Glenn Brynes, Ph.D., M.D.

Copyright © 2006  Northern County

Psychiatric Associates

Last modified:

October 04, 2007

 

 

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