How do I know ADD/ADHD/Bipolar Child

[jilldai]

I am sooooo frustrated right now. I am concerned for my daughter who is 11. First, I have read the Bipolar Child, Is Your Child Bipolar, and ADD/ADHD books. I have a medical background and very knowledgeable about things medical. My daughter has been showing symptoms that are half ADD/ADHD related and half Bipolar Child related. The symptoms are about half of each. I have taken her to a psychiatrist who said she MAY have a mood disporder (unipolar)  and put her on Trileptyl. She had an allergic reaction to this and we had to stop it ASAP. He did not want to try anything else right now as she is overweight and other meds will possibly increase her weight. S we are watching and waiting. For a second opinion, I went to a pediatric neurologist. I brought the diaries I keep on her, symptoms I see, etc. I am very thorough and have done extensive research! The doctor did not have much to say except that it is difficult to diagnose when they have such similar symptoms. He decided to put her on Concerta. After reading about this medication, I decided not to give it to her right now. In her biological father's history there is high risk for substance abuse and Concerta is similar in structure to cocaine. I do not want to give her meds if this is all hormonally related. She sees a counselor and the counselor does not see any behavior in her history that suggests either disorder. I am very confused, frustrated, out of money and would like some opinions/advice. Help? Any ideas greatly appreciated.

[Rebecca Resnik, PsyD]

Hello,
   the reason you are finding so much disagreement among clinicians is that the subject of bipolar disorder in children is still very controversial. It can be extremely frustrating to have all the experts disagree on diagnosis, but even without a diagnosis you can do a lot to help your daughter.  I will tell you my own bias first regarding pediatric bipolar, then give my thoughts for what to do. I believe that pediatric bipolar is over diagnosed at this time. The information in The Bipolar child can be very helpful for struggling parents, however, not all clinicians would agree that the behaviors as Dr. Papolos describes them are necessarily indicative of bipolar disorder. I do not agree with the current tendency to label every child who has a behavior problem and high levels of irritability as bipolar. I agree with those who argue that it is not bipolar unless there are observable vegetative changes (such as changes in need for sleep)  that occur with manic/hypomanic states. I am also not convinced that rapid mood cycling among children indicates bipolar as opposed to cyclothymic disorder, or a disruptive behavior disorder such as ADHD or Oppositional Defiant Disorder. The primary differences in differentiating ADHD vs bipolar are the vegetative changes and true cycles in mood, not just behavioral problems. So in short, I think we are all still learning, and I am very conservative in giving a pediatric BP diagnosis.

    Whatever the underlying neurological process, your safest path (though perhaps not the cheapest!) is to pursue symptom reduction through psychotherapy. I would ask your pediatrician or neurologist for a referral for a comprehensive neuropsychological or psychological assessment. The testing will tell you definitively if your daughter has significant impairments in sustaining attention, ignoring distractions, and perseverance that will determine if she truly has ADHD. I would recommend an emotional assessment as well, particularly since the psychiatrist was concerned about a mood disorder. I realize this is expensive, and that you may have to be on a wait list for quite some time, but it seems that your daughter's case may be sufficiently complex to warrant a full assessment prior to further medical interventions.

   Regardless of the diagnosis, your biggest priority is to help manage and reduce your daughter's troubling symptoms. You may wish to seek psychotherapy from a psychologist or other doctoral level professional with expertise in mood disorders. When a child is displaying troubling behavior, research shows that working with the parents on developing their behavior management skills is a highly effective treatment method. I would seek a psychologist who can provide Parent Management Training (similar techniques are Parent Effectiveness Training, Parent guidance and training in behavior modification). You are likely to find that learning effective behavior management techniques has a significant impact on her symptom severity, and may even make life bearable without medications.  

    I would recommend you get the book The Kazdin Method for parenting the Defiant Child by Dr. Alan Kazdin. Dr. Kazdin is one of the foremost experts on managing behavior in children with severe behavior problems, and his book is very user-friendly. If your daughter has rages, try The Explosive Child by Dr. Ross Greene. Finally, a great one for improving your communication with your child is How to Talk so Kids Will Listen and Listen so Kids Will Talk by Adele Faber. The last book is an excellent guide to avoiding and diffusing power struggles and helping your child express feelings with words instead of unpleasant behavior.

Best Wishes
Rebecca Resnik
Disclaimer: This Medhelp post is written for informational purposes only. It is never intended to replace face-to-face psychological and medical care. This post is not intended to create a patient-client relationship, nor to give or rule-out a diagnosis.

    

[RDPuff]

Thank you for this wonderful response!  You have brought out several points that have broadened my perspectives with our behaviorally challenged child.  He does have a firm ADHD and RAD diagnosis and has benefitted significantly from Ritalin meds but we see some signficant mood cycling starting up again.  We, too, have been through conflicting diagnoses from different professionals.  We just keep monitoring.