ADHD misdiagnosis as a bipolar disorder often occurs due to similarity of symptoms, making an accurate diagnosis challenging. If you follow news, you must know about the explosion in the number of children and teenagers being diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Many parents also aware of very serious mental health condition called Bipolar Disorder. These two conditions often have overlapping symptoms, particularly in teenagers. However, it is extremely important for a child to be properly diagnosed in order to receive an appropriate course of treatment. As a parent, you can often provide the vital information necessary for a diagnosis to be made and/or confirmed. This is especially important for many teenagers, who are likely to be less-than-forthcoming regarding their behaviors and moods.
ADHD Symptoms in Children
Attention Deficit Hyperactivity Disorder (ADHD) is a very commonly diagnosed (often mis- or over-diagnosed) condition in children and teenagers that is characterized by persistent symptoms of inattention, hyperactivity, and impulsivity that impair daily functioning.
The symptoms of ADHD might include the following:
- Rapid, often impulsive, speech (for example, taking “a mile a minute” or blurting things out without much thought)
- Physical restlessness (constantly moving, fidgeting or twitching; inability to sit still for extended periods of time)
- Difficulty focusing or attending (jumping from one idea to the next, daydreaming or “losing” thoughts frequently)
- Irritability (Being cranky or moody more often than not, usually due to getting into trouble for some of the above mentioned issues)
- Oppositional or defiant behaviors (Acting out; for example, yelling, being “mouthy” or otherwise not following rules and expectations).
(Visit this page for more details regarding symptoms of ADHD in children and teenagers)
You might be reading this list and saying “Isn’t that all teenagers?” And to a certain extent, you are right. Adolescence is a time of rapid change, and it is also a time of unpredictability in a child’s life. This can definitely lead to periods of distractibility, restlessness and irritability. However, it is important to remember two key points – in order to be diagnosed with ADHD, symptoms must have started before the age of 12 years and they must be significant enough to impact the teenager’s life in a negative way (i.e. impairing everyday function).
If left untreated, ADHD can have long-lasting effects on a child's development. It often leads to poor academic performance, social difficulties, low self-esteem, and increased risky behaviors during adolescence. Children with ADHD are also at higher risk for developing conduct disorders, anxiety, and depression.
However, early intervention and treatment is important to help children with ADHD reach their full potential. Effective treatments include behavior therapy, classroom accommodations, social skills training, and stimulant medications like Ritalin when necessary. With comprehensive treatment, children with ADHD can thrive academically and socially. Ongoing support helps them build critical skills to manage their symptoms and become successful adults.
With rising ADHD diagnosis rates, online screening tools provide accessible initial assessments to determine if ADHD testing is warranted for your child before confirming with a medical provider. Our free, evidence-based online evaluation gauges ADHD risk factors in under 3 minutes. While not diagnostic, scientifically validated screenings can measure ADHD markers including inattention, hyperactivity, and impulsivity. We provide guidance on whether your child’s symptoms merit getting assessed further through formal evaluations and is an easy first step toward getting the help your child needs if ADHD is suspected.
Symptoms of Bipolar Disorder in Children
Bipolar disorder is a mental health condition characterized by extreme shifts in mood and energy levels. There are several types of bipolar disorder that can present differently in children versus adults:
- Bipolar I causes episodes of severe mania alternating with depression. Mania may include heightened energy, impulsiveness, and risky behavior for at least 7 days.
- Bipolar II causes milder manic episodes (hypomania) alternating with depression.
- Cyclothymic disorder involves chronic, fluctuating hypomanic and depressive symptoms that don't reach full manic episodes.
In children, bipolar symptoms may be different than adults. Mania in kids is more often irritable or angry, rather than euphoric. Increased energy takes the form of restlessness and aggressive behavior, rather than productive activity. Bipolar symptoms can also overlap with other conditions like ADHD, conduct disorder, and anxiety disorders.
Bipolar disorder, unlike ADHD, is a mood disorder, although it has very similar symptoms to ADHD. However, the symptoms of bipolar disorder, especially the restlessness, irritability and defiance, tend to be more severe or more intense. There are also some other telltale signs to look for when it comes to bipolar versus ADHD. For example, bipolar disorder symptoms often include:
- Severe mood changes that occur rapidly, such as being extremely happy one minute and overly sad the next.
- An overall increase in your child’s energy level, almost as if he/she is the Energizer Bunny
- A lack of sleep, but your child does not seem lethargic or tired
- Engaging in risky or troublesome behaviors; for example, drinking, using drugs, engaging in unprotected sex or spending large amounts of money
After a diagnosis, managing bipolar disorder in children requires a combination of medication, therapy, and family support. Mood stabilizing medications like lithium help smooth out mood swings. Antipsychotics can treat mania and antidepressants may be used for depression. Therapy provides coping skills while assisting parents in managing their child's symptoms and behaviors at home.
A structured home environment with positive reinforcement for good behaviors is key. Parents should avoid harsh criticism and establish clear consequences. Tracking symptoms, sleep, and mood changes helps optimize treatment. Support groups allow families to share advice and feel less alone. With diligent management, children with bipolar can gain control over their symptoms.
Comparing ADHD vs Bipolar in Children: Similarities and Differences
So, what are some of the signs of ADHD and bipolar disorder? More importantly, how are they alike and how are they different? Knowing what to look for in your teenager’s everyday behavior can help your doctor or psychiatrist/psychologist make an all-important diagnosis much sooner – which means sooner, more effective treatment.
While ADHD and bipolar disorder share some overlapping symptoms, there are key differences in how the conditions manifest across demographics:
- Age: ADHD symptoms can appear in early childhood, but the DSM-5 criteria specify that several symptoms should be present before age 12, while bipolar disorder more typically emerges during adolescence. However, diagnosing bipolar in children under 10 remains controversial.
- Gender: ADHD is diagnosed more frequently in males, but recent research suggests that the disorder may be underdiagnosed in females, who may present different symptoms than males. Therefore, the gender ratio may not be as skewed as traditionally thought. Bipolar disorder affects males and females equally.
- Symptoms: Both conditions include impulsivity and hyperactivity. But bipolar also causes discrete manic/depressive episodes, versus ADHD's more persistent symptom pattern.
- Co-occurring conditions: ADHD commonly coincides with learning disabilities or conduct disorders. Bipolar is more associated with anxiety disorders and substance abuse.
- Response to treatment: People with ADHD often improve with stimulant medications like Ritalin, while bipolar responds better to mood stabilizers like lithium.
Recent neurological research shows some overlap as well as differences between the two disorders. Brain imaging reveals that both ADHD and bipolar disorder involve abnormalities in prefrontal cortical circuits regulating emotion, cognition, and behavior. However, bipolar appears to also involve deeper limbic system disturbances.
Genetically, ADHD has been linked to variations in dopamine system genes affecting neurotransmitter function. While bipolar disorder involves anomalies in circadian rhythm genes influencing mood regulation. There are some shared genetic risks, but the conditions have distinct underlying biological contributors. Understanding these complex neurological and genetic factors will enable more targeted, personalized treatment approaches for both disorders in the future.
Manic and Depressive Symptoms of Bipolar Disorder
These symptoms, which tend to mimic ADHD, are also known as the manic phase of bipolar. Signs may include:
- Feeling euphoric, frenzied, or irritable
- Decreased need for sleep without feeling tired
- Racing thoughts and rapid speech
- Impulsiveness and risk-taking behaviors
- Inflated self-esteem or sense of invincibility
For example, a child experiencing mania may talk and joke constantly, have boundless energy, and impulsively engage in dangerous activities like reckless driving or spending sprees.
These are usually followed by a depressive period, in which your child may show the following symptoms:
- Low or depressed mood, which lasts for more than a few days
- Lack of interest in enjoyable activities, which may manifest as skipping practices or not talking to friends
- Sleep problems, such as insomnia or sleeping too much
- Lack of energy, lethargic (for example, laying around or moping about)
- Feelings of guilt, hopelessness or worthlessness
- Thoughts of death or suicide
A child in this phase may sleep excessively, isolate socially, neglect self-care, and believe their family would be better off without them.
For families coping with a bipolar child, establishing structure and routine helps stabilize mood swings. During mania, gently encourage rest and avoid overstimulation. For depressive periods, support engagement in positive activities and therapy. Track symptoms closely and communicate with your child's treatment team. Join a support group to share advice and feel less alone in managing this condition long-term. With compassion and care, children with bipolar can thrive.
The Challenge with Misdiagnosing Bipolar vs ADHD in Children
Misdiagnosing bipolar disorder as ADHD or vice versa can have serious consequences, as the treatment approaches differ significantly. While stimulant medications used for ADHD may trigger mania in a bipolar child, it's also important to note that some individuals with both ADHD and bipolar disorder may benefit from a combination of mood stabilizers and stimulants, under careful medical supervision. On the other hand, a mood stabilizer may relieve bipolar symptoms but not address ADHD challenges.
Getting an accurate diagnosis is critical but can be complex. For instance, Sarah was diagnosed with ADHD at age 10 but continued struggling academically and socially. At 13, her symptoms worsened - energy levels fluctuated wildly, she began sneaking out at night, and she described depressive thoughts. Reassessment suggested bipolar disorder as the underlying cause. With mood stabilizers, Sarah's cycling symptoms stabilized.
Due to symptom overlap, getting a second opinion from a child psychiatrist or psychologist is recommended whenever there is doubt. They may perform more in-depth behavioral assessments, symptom measurements, family histories, or neurological testing to differentiate between conditions. Multidisciplinary teams combining social workers, therapists, and pediatricians also enhance the accuracy of diagnosis. Ongoing research is improving diagnostic criteria and tools, but thoughtful clinical assessment remains vital.
One major way to tell the difference between ADHD and bipolar disorder is by comparing the “manic-type” symptoms. For example, the manic symptoms of ADHD tend to be more mild (even subtle) and last over longer periods of times (months and years). The manic symptoms of bipolar disorder tend to be more severe (or heightened) and only last a short amount of time (a few days up to a week). They are then followed by the depressive period, which lasts about the same amount of time. This type of cycle continues in true bipolar disorder (at least when it is not treated).
Early Signs and Intervention for Children with ADHD vs Bipolar Disorder
Recognizing symptoms of ADHD and bipolar disorder early is key to getting children effective treatment and support.
Some early developmental signs that may indicate ADHD include:
- Delayed development of motor skills like riding a bike
- Impulsiveness and volatile temper from a young age
- Difficulty focusing or sitting still during story time or play
- Delayed speech development
Early markers of bipolar disorder are more subtle but may include:
- Extreme reactions to changes in routine or environment
- Intense mood swings even as a toddler
- Signs of rage, anxiety, or depression by ages 5-7
- Trouble sleeping and irritability from a young age
If you notice these red flags, bring them to your pediatrician's attention for monitoring or evaluation referrals. Don’t delay - getting assessed and treated before age 12 leads to better outcomes.
Once diagnosed, early intervention services can help both conditions immensely. Many public school districts provide staff like psychologists, occupational therapists, and special education teachers to support learning for neurodiverse students. Seek an IEP evaluation for your child. Community resources like social skills classes, respite care, and family therapy are also extremely valuable. Ongoing collaboration between parents and teachers provides consistency across home and school environments. Early, compassionate support empowers children with ADHD or bipolar disorder to thrive.
If you notice your child acting in the above-mentioned ways for at least 2 weeks, you may become concerned and want to call your doctor. You will want to make a list of symptoms and their duration. You’ll also want to note the severity of symptoms as well. Above all, if you notice that your child is extremely depressed, lethargic or even suicidal, don’t wait 2 weeks. Call your doctor immediately or go to your local emergency room for immediate assistance.
Evolution of Diagnostic Criteria and Societal Perception of Bipolar Disorder and ADHD
The diagnoses of ADHD and bipolar disorder in children have evolved significantly over the past few decades. While symptoms resembling ADHD have been described for centuries, the term 'ADHD' was not introduced until the third edition of the DSM in 1980. The criteria for diagnosing ADHD have expanded over time to include more behaviors and symptoms. This has led to a sharp increase in ADHD diagnosis rates, from around 3-5% of children in the 1970s to over 10% today.
While the recognition of pediatric bipolar disorder has increased since the 1990s, the concept of bipolar disorder in children has been discussed in the medical literature for much longer. Previously, manic and depressive symptoms in youth were often misattributed to other causes. The introduction of psychiatric medication for children in the 1990s enabled more aggressive treatment of early-onset bipolar disorder. However, some experts believe bipolar disorder continues to be both under diagnosed and over diagnosed in children.
Societal and cultural factors have also influenced the perception and diagnosis rates of these disorders over time. For example, the stresses of modern life and technology use have been implicated in rising ADHD rates. Additionally, greater awareness and reduced stigma around mental health conditions have led more people to seek treatment. On the other hand, factors like overcrowded classrooms, lack of physical activity, and increased academic pressure may also be mistaken for symptoms of ADHD. More research is still needed to understand these complex factors influencing diagnosis.
In Summary
Careful and continuous monitoring is key for children exhibiting potential ADHD or bipolar disorder symptoms. Open communication with medical providers allows adjusting treatment plans as needed if new issues arise over time. Parents can also connect with support groups and community resources to get guidance managing medication changes, behavioral setbacks, or other challenges. While early diagnosis is crucial, ongoing follow up care ensures these conditions remain controlled so children can keep thriving.
References:
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