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

*Forgetful

*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!