About our Daughter

I am mother to four wonderful daughters, ages 17, 19, 21, and 23, and wife to the greatest husband on earth. God has given us a special child to raise one who was diagnosed with early-onset bipolar disorder at the age of seven, though she showed signs of it from the age of fifteen months. She also has ADHD, Sensory Integration Disorder (sensory seeking), Dyslexia, and Non-Verbal Learning Disorder-NOS, all typical comorbidities for a bipolar child. In spite of the trials, she enjoys lacrosse, running (finished her first marathon in October of 2014!), and reading and writing her own books. I will share with you the many joys and sorrows we have faced and will face in the future with the hope that you may find better understanding about this mental illness caused by both chemical and structural abnormalities in the brain. I desire that you will be encouraged by this blog if you are also dealing with a bipolar child. Thank you for reading and sharing in our journey.

How Did You Know She Was Bipolar So Young?

I wrote a long explanation of how we came to this bipolar diagnosis in a child so young under my post of March 19th of 2009. If your child or a child you know bears similarities, please seek out a good psychiatrist and don't wait for "things to get better." Often they will simply get worse, and the longer a child is unmedicated, the more damage their brain can accrue. Early diagnoses and treatment are key to providing these children with a chance at a successful life later as a teen and an adult.
Never change, start or stop a medication without the approval of your child's physician!

Wednesday, March 24, 2010

Knowing the Difference Between ADHD and Early-Onset Bipolar Disorder

I have had many questions and comments from readers asking about their child's symptoms, medications, and what sounds to me like a possible misdiagnosis of ADHD when their child may very well have early-onset bipolar disorder. I am going to list the similarities and differences below. No one but a very good psychiatrist can make an official diagnosis of your child, and sometimes they can be resistant to the bipolar diagnosis, as I have seen many times. This is just something that you may find useful to try to figure out your child's behaviors and seek the right help. I have summarized these lists (there is more) from "The Bipolar Child" by Dr. Demitri Papolos, and you can find this information in chapter 2 of the third edition.

A Child with ADHD:

*Child cannot focus on details, makes careless mistakes on classwork
*Cannot keep attention during tasks or playtime
*Seems not to hear you when addressed, doesn't listen well to instructions
*Doesn't complete assignments or chores in the allotted time
*Disorganized at home and at school
*Hates homework, can't do it without a struggle
*Always losing their "stuff"
*Immediately distracted by external stimuli
*Fidgety: tapping fingers, kicking feet, humming all the time
*Always on the go, can't sit still for long
*Very impulsive: interrupts conversations, cuts in front of lines, can't wait for others to have a turn, grabs things without asking
*Chatterboxes: want to tell you everything they are thinking all the time
*Often extremely bright, but their grades don't show it because of missing assignments, bad tests, etc.
*Sometimes, even frequently, can be explosive and angry (the "ring of fire" ADHD.)

A Bipolar Child:

*Also explosive, irritable, and has fits of anger, BUT in contrast to kids with just ADHD, will punch holes in walls, doors, try to hit you, bite you, do physical damage to house, and sometimes to others.
*Hypersexual: you may catch them masturbating a lot, or trying to view porn, playing "doctor" with siblings or other children
*Unbelievable temper tantrums that last a LONG time (I frequently called my husband to come home from work to help with Caroline when she was 3 or 4--I couldn't handle her!)
*Sleep issues: waking up in middle of the night and not being able to fall back asleep, etc.
*Often way too "rough" on the playground
*Always imagining battles, playing super hero, to the point of even jumping off of the top of jungle gyms, roofs, etc.
*Obsessive thoughts that are often morbid in subject
*Tunnel vision: get an idea in their brain and cannot let it go, usually "missions" like building a fort, making "potions," needing a certain pair of shoes or item of clothing or toy right now or they act like they will die (huge temper tantrums if denied, even if very unreasonable.)
*Irritable all of the time, snap easily
*Racing thoughts, and speech
*Seem unafraid of very risky actions
*Crave carbs, and will hide them in their rooms
*Compulsive lying or fantastical storytelling
*Aggression, often taken out on siblings and parents, not necessarily peers or teachers
*Disorganization in schoolwork and their room, get overwhelmed by homework because they can't organize it or break it down into smaller pieces
*Suicidal thoughts, expressions
*And other symptoms like tics, learning disorders, hallucinations, both auditory and visual
*If put on an ADHD stimulant med alone, or an antidepressant alone, will react very badly by entering into full-blown mania, often needing hospitalization if not caught early enough

As you can see there are some similarities between ADHD and bipolar disorder, but also some BIG differences. Our daughter experienced all of the above bp symptoms, and still does, but all of these are greatly lessened when she is on the right mix of meds. Of course, a child can be both ADHD and bipolar, which is the case with Caroline, and many bipolar kids. Most bipolar kids cannot tolerate ADHD meds. Also, they can have OCD with bipolar disorder, as well as a number of other neurologically based problems, like Tourettes, Aspergers, Oppositional Defiant Disorder, Conduct Disorder, and sensory processing issues. Even something like a brain tumor can produce bipolar symptoms, so it is so important to get a thorough work up by a well-informed psychiatrist, one who doesn't dismiss your concerns but really listens.

I hope this might help someone who is wondering if their child is possibly bipolar, or who has been told they are ADHD, but are not responding to ADHD meds, perhaps getting worse. Don't "wait and see" if they are on an antidepressant alone and acting strangely--our child nearly killed herself at the age of seven because we waited to see if she would act more normal. Trust your instincts!


asplashofsunshine said...

Thank you, thank you! We are still in the very early stages of treatment without any diagnosis. This helps tremendously. Did I say thank you?!?! :)

Megan said...

You are so welcome!!

Accidental Expert said...

Great post! Its so hard to sort out what symptom is what.

We're still trying to figure this out ourselves, but I have to say our girl has symptoms from both lists.

BTW...her meds are better and her brother is now on Intuniv and so far so good.

revisedfully said...

Excellent, spot on, post with great knowledge especially for those still trying to get an accurate diagnose-any co-existing conditons!


Essie the Accidental Mommy said...

It is striking how much overlap there is with the different diagnosis kids can have. Hopefully the new DSM will clarify....

Pickel said...

There are also a lot of overlaps in children with fetal alcohol, and sensory processing. It is very difficult to decipher which ones we're dealing with everyday. My guess is that the bipolar is the one surfacing most of the time.

Bobby said...

That just summed up my childhood. Wow hahaha. I never realized all of that had to do with Bipolar until I just read it. That's just a depressing blast from the past lol :)

Camille said...

My daughter evolved from ADHD into BP during 8th grade. I can relate to the symptoms from both lists. I was the mother carrying her kid out of Wal-Mart, sideways, while she was screaming her head off and thrashing because she didn't want to leave. Meanwhile everyone was staring at me and I felt horrible.
Just a comment on the carbohydrate cravings... I have to hide all sugars from my daughter or she will eat them (secretively) with a spoon. Makes my teeth hurt just to think about it!

stephanie said...

We are talking with meridell about our son. Do you recommend it there? It's so hard to send him away but the situation at home is unbearable--so oppositional and meds have not stabilized him. I feel so overwhelmed and was hoping for any advice since you have been there. I am concerned about school as they said we would need to withdraw him and put him in texas system. Was this how you did things? He is in private school and I was hoping he could stay on task there. any questions we should ask or advice would be so welcome!

Megan said...

Stephanie--Meridell was such a turning point for our Caroline. I would do it again in a heartbeat if she needed to go. I loved her counselor, the doc was great (hard to get a hold of sometimes by still impressed by him) and she got the intensive therapy and med adjustments she needed. The school was just fine--not as challenging as what your son is doing right now, but they do school through the summer and the teachers are very caring, compassionate folks. Caroline's academic confidence was restored there and she hasn't looked back since, just roars ahead. I would try to get him into Meridell ASAP and realize that you will benefit from the break so much! It is hard, but after a few weeks you realize how healing it is to not be in constant crisis.

marythemom said...

Stephanie - my children both went to Meridell. For neurological assessments it was superb. I recommend it too.

School is not year round at Meridell. They are on the same school year as their local school district. The ratios are lower than most schools though (I think it was a max of 8 to 1).

We live near there and my son was there about 6 months. My daughter was only there a little less than 2 weeks. I'd be happy to try to answer any questions.

Mary in TX
mbrush at austin dot rr dot com

Kim said...

I never knew about the carb cravings, but it makes perfect sense. Like Camille said, my son would also eat straight sugar if I'd let him (and I HAVE caught him). I also see myself in so many of these, but never got my dx until I was 37.

Liana said...

Hi Megan. What a great read. All of the symptoms you covered for a BP child are amazingly accurate. I was diagnosed in 1993, tho after reading these symptoms it was like reading my own childhood history. Yes, that was me way back then at a very early age according to my mother.

Liana said...

Wow, great read. I suffered from all of the symptoms you covered, though was diagnosed at the age of 24 in 1993.

Megan said...

When Caroline was at Meridell last spring and summer, they had school til the end of June, then still would go to the classroom in July and August for laid back school sessions, mostly just reading and discussions. They started school around August 19th I believe.

Megan said...

I have questioned several times if I am bipolar, but I don't meet the checklist on the major stuff. Sometimes I wonder if I am BP II though, the milder swings. Or maybe I am just a stressed out mom!!

marythemom said...

I have a strong family history of bipolar so even though I showed very little mania I looked into it in college (lots of depression). They told me it was "learned behavior!" I crammed all night before exams, took on huge projects, never said no to anyone, finished projects as quickly as possible... or not at all. They gave me some Xanax and put me on antidepressants.

It wasn't until we adopted our sibling pair (I was 36) and I was under more stress than ever that I was rediagnosed. My therapist said I was bipolar all along (people cram all night for exams all the time, but not usually without without caffeine or drugs!). I take mood stabilizers now, but hopefully when our oldest leaves home in a couple of years the stress will alleviate and I can drop or at least lessen them.

Mary in TX

Mary B said...

I have a 12-year-old son with a mood disorder diagnosis and then three other that he comes close to fitting: bipolar, ADHD and Asberger's. He does fairly well on 6 mg of Invega once daily; however, he can't seem to handle school. We have had a break due to summer, but I am feeling the anxiousness return as we look foward to another school year of one horrible day after another. A few years ago, we tried Strattera for a week and it was like a miracle -- truly amazing. Then he developed a rash and we had to quit. the doctor says it couldn't have possibly had any affect on him since it was only a week, but it was truly amazing, so what can we say? Anyway, he has been kicked out of middle school and goes to the district's alternative school. The only thing this has done for him is taught him to cuss. Anyway, it's not unusual now for this sweet, caring boy to get angry and throw furniture at school and cuss out his principal, and then a few minutes later he's perfectly fine. Anyway, long story short, I'm wondering about Intuniv. Maybe it would work like Strattera (even though the dr. says it didn't have time to work), but maybe not cause the rash.

Megan said...

Mary B- I am so sorry that your son is not very stable right now and that school has been such an issue. I can relate completely to the being kicked out of school. Caroline was at several different schools prior to this past year, never staying for a full year. Intuniv might be a great alternative to Strattera . I developed a rash after starting Vyvanse, so even though it is rare, I guess it can happen. What other meds is your son on?

Mary B said...

Thank you for answering so quickly. Chase is just on 6 mg of Invega once a day. He does fairly well at home, but just not in the school setting or sometimes on outings. He can act just like a two-year-old at the store at times if I don't allow him to buy something he sees that he wants.
Anyway, I called the psychiatry office where he is seen and they have scheduled an appointment with me to talk about the possibility of putting him on the medicine. I just wonder why they haven't in the past, because I keep telling them about his school problems and they say there is just no new medicine. But then I asked today and they have other patients on it. It's difficult to get answers from them. They just seem overworked and overburdened with all the children they deal with.

Megan said...

Mary B-it sounds like your son definitely needs something like Intuniv or even another mood stabilizer. Have they ever suggested something like Trileptal? Or amantadine? As hard as it is, a lot of times these kids needs more than one drug. We were very resistant to adding on more meds, but now she is on seven and is the most "normal" she has been in forever. I hate that she has to take so many, but we will do whatever it takes to help her be stable and achieve her dreams. Hang in there!

marythemom said...

I'm a Mary B with a son with similar issues so I had to look twice at this. :) I agree with Megan it sounds like your son needs more than he's getting. My son (actually my daughter is too) is on a cocktail of meds and just one or two didn't make enough of a difference. He just kept getting more and more violent until they found the right combo.

I'd be happy to talk with you about it if you want to e-mail me mbrush at austin dot rr dot com.

Mary in TX

helcha37 said...

I have a son who has been diagnosed bipolar and adhd. I found this very helpful. He is a sophmore in highschool and was dumped in an alernative school that basically is a warehouse for children with all kinds of emotional problems. This seems to be etting him up for failure and he blowes up because he get's anoyed and can not control it. He is on adhd meds and geodon, wich seems to be intensifying the problem. I am in the processs of hiring an advocate for a more appropriate placement and an evaluation to possobly change his meds Can anyone recomend a setting in public school that would be helpful in mamageing him without contant expulsion. $ days of school, He walked out the first day and today eas expelled for blowing up and swearing! By the way i found your explanation of the differece of bi polar and adhd very helpful! Thankyou!

Megan said...

Helcha37-I am so sorry your son is experiencing such a difficult time in school right now. I completely understand the struggle to find the right kind of school situation for your bp teen. There are so few great options it seems! I am wondering which ADHD meds he is on, and if you have heard that stimulants can make bp disorder much worse in most cases. Have you tried other meds? Geodon works great for some kids, but for my dd it actually made her aggression worse. Finding the right med mix is critical to enabling them to handle school.

As far as public schools go, I don't have as much experience as others do out there. With all of the horror stories, and our own brief terrible 9 week experience with public school, we have sought to keep her in private schools, or homeschooled her. From what I have learned on the CABF parent support groups, the success of a bp kid in public school seems to depend on the willingness of the administration and individual teachers to comply with their IEP. I think you are right on in requesting an advocate. Sometimes that is the only way to get what your child needs.

Also, how is your son at home? Is he as explosive at home as he is in school? What state are you in?

Check out the Child and Adolescent Bipolar Foundation website with the link on my blog if you are not familiar with it. They have great resources, often by state.

Hang in there! I know it is tough!

corinnecmcc said...

Part 1 of comment (sorry, thsi is long, but I need to say/ask all of this!)
This is an eye opening and depressing list. My son is 20 and twice-exceptional, and staggering under a load of issues. He has struggled with depression since he was 7, and with each round of psych-ed testing, another LD or mental issue was added: currently, we are working with dysgraphia, fine motor planning, ADD (inattentive), Tourette's, slow processing speed, depression, an incredible inability to fall asleep and then to wake up which is still being investigated, anxiety disorder, nonverbal learning disorder, and the newest -- a drug-induced psychotic manic break during which he was convinced he had founded a new religion that would save the world, and that he was the chosen one to bring it to the rest of us. The various professionals he has seen since the breakdown in February do not think he is bi-polar, but wow -- I could check off nearly all of the things on your bipolar list, from when he was in grade school. No one suspected bipolar then. Or perhaps I should say no one mentioned it to mom and dad.

He is currently in university, in his second semester of freshman year, having had to withdraw due to the breakdown in February. But he is still unable to awaken, so is sleeping through classes. He is having a hard time concentrating on homework so is getting panicky because he is getting behind. We didn't want him to return to school so soon, but he was very determined, and the staff at the hospital where he was an inpatient for mood disorders in August told him he was ready to go back. Hmmm.

We have tried so many things, worked with so many people, and my heart is breaking now, because it seems we still haven't found the right things to help him. |Yet, he has done well in school despite great struggles, is a gifted singer and actor, writes beautifully, has a wonderful sense of humor, is a kind, empathetic and dignified young man.

corinnecmcc said...

Part 2 of comment

We are Americans currently living in Toronto, where we moved from London, England. He was born near Chicago, but in kindergarten we moved to TX and the awful public schools there, where all his problems manifested. His dr then said moving to a foreign country would be better than the school he was in, so off we went when the job offer came through. So he has dealt with professionals (and differing attitudes and classifications) in three countries. I sometimes think that I have become a professional advocate for him and his older brother who also has ADHD and anxiety disorder, but who has managed to graduate university with honors and is now living in Boulder.

Currently, my younger son is taking zyprexa for the mania and prozac for the depression. He is off all ADD drugs, which were Concerta and Strattera. His excursion into marijuana use was intense, but I believe was limited to this past winter. I believe that the various drs have successfully impressed on him the dangers of using it again, and the damage it will cause to his brain if he induces another manic break.

This past summer I spent a lot of time researching NVLD, which was the result of the most recent round of psych-ed testing. It seems to encompass all of his problems. This list in your blog, though, has me thinking hard about his past, with tears in my eyes.

It is so hard sometimes to parent a child like this. Despite constant research, discussion, searching for appropriate professional help, we seem to have not yet found the proper combination of help. Now I am looking for a therapist still willing to do talk therapy, at the suggestion of his ADD specialist, to help him come to terms with this stew of problems and the impact it has on his life. We are also in the midst of a referral process to find someone who can supervise his meds at school. He is only 30 minutes from us, but all the professionals think he needs to be overseen by someone local to him.

Sorry this is so long. This has been a very hard week, as we only just realized that he had stopped taking his meds quite abruptly two weeks ago (so he could party during new student week --aargh!) then restarted them a week ago also on his own decision, and we are still trying to get him back on track. You can imagine the plummet into depression he suffered last week. He wants to stay at school. Really wants to stay. We have appointments scheduled for the sleep study follow up and for a program near his school to monitor him for mood disorders. I am feeling helpless and so sad, but he is 20 now and has to begin handling some of this on his own. Advocate for himself, or he will never learn how to manage his own life. And besides, I really don't know where else to turn or what else to try. I'm open to any ideas or comments.