Last week I saw an 18 year old, whose mother is convinced he has ADHD. She's probably right. However, he may also have a Bipolar condition. The Bipolar Disorder, if he has it, might actually account for some or even all of his attention/distractibility problems. I've seen at least one adult on a stimulant have better attention/focus abilities when she was off the stimulant and on a mood stabilizer. Should this 18-year-old be given a stimulant?

Mood stabilizers do not seem to make ADD worse, but a stimulant could make bipolar disorder worse. This is not firmly established nor agreed upon. However, for the moment, caution seems warranted. For example, here is Dr. Faedda, quoted by Dr. Papolos -- two of the leading researchers on bipolar disorder in children: "It should be emphasized that antidepressants can cause a trial of a mood stabilizer to look as though it has failed because the antidepressants can be very destabilizing for a child or adult with bipolar disorder. Stimulants can do the same thing." (This is controversial; there are no sufficient data to say yes or no on this debate at this point).

to read on... http://www.psycheducation.org/PCP/handouts/ADHD.htm

I found another good article on this topics at: http://www.addconsults.com/articles/full.php3?id=1585

Here is a short section from the article.

Children are incapable of presenting many manifestations of bipolar symptoms described in adults. Studies have shown that five behavioral symptoms in children/early adolescents aid in correctly diagnosing childhood bipolar disorder. These manic symptoms which do not overlap with ADHD are elation, grandiosity, flight of ideas/racing thoughts, a decreased need for sleep, and hypersexuality (in the in absence of sexual abuse or overstimulation). These five symptoms provide the best discrimination of childhood/early onset bipolar patients from uncomplicated ADHD patients. Irritability, hyperactivity, accelerated speech and distractibility are frequent in both pediatric bipolar disorder and ADHD and are not useful in differentiating between the two disorders. Mixed mania (simultaneous mania and depression) is highly prevalent in childhood bipolar disorder.

Thanks both of you. I don't know how I missed these.

You know since I was just diagnosed, we are looking very closely at my 15 year old who continues to have issues even after teh ADD dx and being on meds.
So much like me.
And the interesting thing about the stims for me, is I cut my dose of Adderall in 1/2 and don't take it as often now, since I started on the Lamictal.
I did a "test" for a month to see how I would be off the Adderall, with the doc's permission, and well I still believe I'm ADD, however , a once believed severe case, has been reduced to more borderline ....ergo the decreased need for the stims.....now I just have a raging case of BPDII ..LOL..

Thanks again, always looking for places to read up on things, it's a big step to see if we mis-dx him too!

Hope