Is it ADHD or Bipolar?

The symptoms of childhood bipolar disorder are less marked than in adults and in many ways could easily be mistaken for ADHD. This has been something of a problem during diagnosis and several cases of misdiagnosis have been revealed. The symptoms of ADHD include inattentiveness, impulsive behaviour and hyperactivity. Childhood bipolar disorder may include mild levels of hyperactivity, temper, irritability and low moods, but interspersed with normal moods. Some experts have speculated whether childhood bipolar disorder is really bipolar at all because it lacks the distinctive transition between mood states seen in adults with the disorder.

If incorrectly diagnosed, a child with ADHD will derive no benefit from being treated with mood stabilizing drugs. Moreover, a child with bipolar may actually get worse if treated with drugs intended for ADHD. Diagnosis of these conditions relies mainly on interviews with parents, questionnaires and behavioral rating scales. This reliance on observation and interpretation has always been viewed as one of the weaknesses in the diagnostic process.

Fairly recently, news from researchers at the University of Illinois at Chicago suggests a more definitive test may be on its way. Researchers used functional magnetic resonance imaging to examine the brains of children with bipolar and ADHD during a simple memory task. Groups of children looked at pictures of facial expressions and were asked to press a button if they saw the same picture repeated. Children with ADHD showed higher levels of dysfunction in the prefrontal cortex region of the brain whereas children with bipolar showed deficits in the emotion-processing and regulation areas of the brain. Such technological developments take time to refine but the fact that neurological markers may one day be available to support behavioural tests is excellent news for parents who worry as to whether their child has been correctly diagnosed.

Parents need to be active in the process of diagnosis and some simple questions and observations are necessary for this. For example, parents should always ask how a particular diagnosis was made. If it seems rushed with little or no use of additional tools to validate the initial diagnosis, this should probably be considered a little worrying. Doctor’s should try to make best use of the information available to them – this includes parental observations and reports from teachers. Effective diagnosis and follow-up is a process. Parents need to be assured that their child is evaluated over time. Although you may complete faith in your family doctor, this is never quite the same as having your child assessed by experts in child and adolescent psychiatry or psychology.

Finally, parents need to keep a close watch on their child once medication is being taken. Medication is often a balancing act between benefits and costs. A few minor side effects might be acceptable if the therapeutic value is seen to outweigh this. However if there is no noticeable therapeutic effect or the side effects are marked these should be discussed with the doctor. It is never wise simply to stop medication without first consulting your doctor.