The Childhood Bipolar Mystique, Part 2: Facts Parents of Bipolar Children Need to Know

The Childhood Bipolar Mystique

Part Two

by Cindy L. Hartman, LPC, NCC

Your child’s pediatrician or counselor has diagnosed your child with ADHD… BUT, you’re just not sure. You sense that something else is at work.

Most parents know their children better than anyone else. If your child has been diagnosed with ADHD, ODD or another mental health disorder and you are not convinced it is a true or COMPLETE diagnosis, read on.

It is happening too often. Children under the age of twelve-years-old, who in reality have Bipolar Disorder, Unipolar Disorder (Depression), or Oppositional Defiant Disorder (ODD), are being MISDIAGNOSED with ADHD. There are times when ADHD 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 the very real possibility that Bipolar Disorder may be the underlying problem. 

So, today we will continue to compare other shared characteristics of these disorders and determine what factors are often key in the Differential Diagnosis of Bipolar Disorder versus ADHD (or ODD) in children under the age of twelve-years-old.

Our last coffee and blog session we discussed some of the “clues” that may lead to a differential diagnosis of Bipolar Disorder rather than, ADHD or ODD. You will remember from our last visit, that children with Bipolar tend to have chronic sleep issues. The child’s sleep issues will eventually negatively impact the health and well-being of his or her parents or caretakers if not properly addressed. Children with Bipolar tend toward intentional or anger-triggered acts of destruction rather than the careless or accidental destruction that typically occurs with a child who has ADHD. Bipolar fits of temper can be lengthy, often lasting up to an hour – or more! The energy released during a bipolar fit is hard for an adult to replicate without succumbing to exhaustion. The Bipolar child will often display intense reactions to limit setting, being told “no”, and “perceived” conflict. Duration and intensity of an outburst can be key indicators in a differential diagnosis. Compare these tantrums to tantrums in the child with a strictly ADHD diagnosis. ADHD tantrums are typically triggered by sensory issues, transitions, or frustration, and usually do not last much more than twenty or thirty minutes. The child in the midst of an ADHD tantrum may initially be red-faced and loud but will usually run out of steam within the first five or ten minutes.

Both the Bipolar child and the child with ADHD experience intense moods that may change rapidly. Children with ADHD do not typically show signs indicative of clinical depression as a primary symptom; however, children with Bipolar typically show signs of depression that often present as inflexibility, lethargy and or irritability. Children with Bipolar are frequently irritable. Chronic irritability is another key in the differential diagnosis of childhood Bipolar Disorder. 

Not discussed in PART ONE of this blog, is the fact that cognitive problems inherent with Bipolar Disorder may make learning during some phases of the illness, nearly impossible. The difference between a child with Bipolar and a child with ADHD is that once the child with Bipolar is past a depressive or manic episode, his or her ability to focus, take in and process information returns. The Bipolar child is able to “get over” the temporary executive functioning deficits of attention and comprehension much like as he or she gets over a case of the stomach flu. (For more in depth information on Bipolar Disorder and education begin your search on line with Janice and Demitri Papolos, The Bipolar Child). Conversely, the child with ADHD may struggle to follow a plot line in a TV show, finish a homework assignment, stay seated during a math lesson or while playing a board game with friends. Frequently, the ADHD child is also hampered by one or more coexisting learning disorders.

• The Bipolar child seems always to be jonesing for a fight. These children appear to enjoy the power struggle.
• The Bipolar child may enjoy the intense feelings that go hand in hand with dangerous behaviors and may seek out activities that create these intense feelings.
• The child often acts as if he or she is invincible.
• Bipolar children as young as two-years-old often exhibit sexual hyperawareness and antisocial fits of energized and inappropriate laughter. 
• A child who is ADHD may engage in similar behavior but the impetuous in the ADHD child is more likely due to inattentiveness or impulsivity.

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ADHD tends to be chronic, but does tend toward improvement to some degree by the time a person is an adult. This is not always the case, but for many adults, time, counseling and medication have mediated the worst aspects of the disorder. Not so, with Bipolar Disorder.

Children with Bipolar approach adulthood with increasingly more severe symptoms as time goes by if treatment is not continued. A major problem in young adulthood and beyond seems to be gross distortions in perception. Reality is often skewed and reading emotional events is particularly problematic for the person with Bipolar. In some cases, without the proper treatment, psychosis, paranoia and acting on sadistic impulses leads to homicide and suicide.

For these reasons and more, it is imperative that Bipolar Disorder be diagnosed as early in life as possible. Research shows that 7% of children attended by a physician in hospital facilities can be categorized as Bipolar. The American Academy of Child and Adolescent Psychiatry states that up to 30% of the 3.4 million children with depression in the United States, may in reality have early onset Bipolar Disorder.

It is heart breaking to know that most persons diagnosed with Bipolar Disorder have coped with symptoms for as long as ten years or more before they were finally accurately diagnosed! Some research indicates that only one in four patients is accurately diagnosed in less than three years.