Are you parenting a child with bipolar disorder, ADD or PTSD?
Part One
by Cindy L. Hartman, LPC, NCC
Your child’s doctor, and possibly even his or her counselor have diagnosed your child with ADD, but, you’re just not sure. You sense that something else is at work. Something maybe a bit darker?
1 – Sleep Issues
Multiple Wakings and Scary Dream Content
Let’s start with sleep issues. Children who have ADD mainly have trouble GOING to sleep.
Children with Bipolar tend to wake multiple times most nights. A child with Bipolar Disorder may seem to fear going to sleep at nap time or bedtime. Night terrors or dreams with violent or gory themes is more prevalent in children with Bipolar.
2 – Destructiveness
Anger – Triggered / Intense / Lengthy
Destructiveness may be present in both disorders but the etiology or origins of that destruction are different.
Children with ADD usually have bouts of “non-angry” destruction, what we would commonly term “carelessness”
Children with Bipolar tend to intentional or anger-triggered acts of destruction. Temper tantrums, or fits are often quite severe and can last 30 minutes to hours.
The amount of energy released during these acts of destruction or during tantrums is very hard to for an adult to replicate without quickly reaching a state of exhaustion. Angry outbursts and displays of raw temper present differently when a child has Bipolar Disorder. Duration and intensity of an outburst are key to a differential diagnosis.
3 – Tantrums
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Conflict-Seeking / Intense
Tantrums in the child with ADD are typically triggered by sensory issues, transitions, frustration, or someone directing a negative comment at the child.
The Bipolar child will often display intense reactions to limit setting, being told “no”, and “ perceived conflict” with authority figures and even peers or siblings. The Bipolar child will actively seek out conflict as coping mechanism to relieve feelings of anxiety, stress, fear, or frustration.
4 – Regressive Behavior
Disorganized Thinking / Erratic Behavior / Rage Blankouts
“Regressive” behavior during angry outbursts is more severe in the child with Bipolar Disorder. What does “regressive” behavior look like? The proverbial fly on the wall in the room with a Bipolar child during a tantrum may witnesses to a greater or lesser degree, dependent on the individual child, the exact environment and the tantrum trigger, a child who’s thinking appears to be disorganized and whose body language and body positions are chaotic, wild, flinging, falling, crashing, smashing, hitting, kicking, biting, yelling, swearing, growling… In some instances, the Bipolar child may not have memory of this “rage-out” or tantrum. A child with ADD rarely displays disorganized thinking, language, body postures and chaotic movement.
5 – Mood
Chronic Irritability
Happy. Sad. Silly. Mad. Moods. Both the Bipolar child and the child with ADD experience moods that may change rapidly. Children with ADD do not typically show signs indicative of clinical depression as a primary symptom; however, children with Bipolar may or may not show signs of depression. (Please note that this does not mean that the child with ADD never experiences feelings of depression in one form or another.)
Children with Bipolar are frequently IRRITABLE. Chronic irritability is another key in the differential diagnosis of childhood Bipolar Disorder.
Children with mood disorders are often hard to arouse, particularly upon waking in the morning or after an afternoon nap. This slow arousal (often lasting hours) may present in irritability, dysphoria, and negative and / or “fuzzy” thinking. Many Bipolar children have somatic complaints such as headache or stomachache when they wake in the mornings.
Conclusion
A child may have ADD, Bipolar Disorder, and possibly Unipolar Disorder, (which is better known as Depression). A child with behavioral and or mood issues may also have Oppositional Defiant Disorder or Post-Traumatic Stress Disorder (PTSD).
Too frequently, children who are in reality Bipolar, Unipolar, or ODD, are MISDIAGNOSED with ADD. There are times when ADD is present in conjunction with Bipolar, Unipolar or ODD; however, if a child is UNDER TWELVE YEARS of age, most clinicians (including medical doctors) do not even consider Bipolar Disorder.
In Part 2 of The Childhood Bipolar Mystique we will compare other shared characteristics of these disorders and determine what factors are key in the Differential Diagnosis of Bipolar Disorder versus ADD or ODD in children under the age of twelve-years-old.
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