View Full Version : Too many kids getting a BiP diagnosis when they may be ADHD or something else?

09-30-05, 08:08 AM
A Dr. once told me that mental illness has always held steady at about 2% of the population.

Here is Barkley from San Fran 2000

"All right, thereís a big deal about bipolar illness among children. People think we over-diagnose it. Some of the estimates have said anywhere from 20-25 percent or more of AD/HD children have bipolar disorder. I donít think so. I think weíre getting ourselves into trouble there because we are changing the criteria for children when we diagnose mania. If real criteria for mania are used itís only around 1-6 percent. Thatís still fairly high. The base rate in the population is well below 1 percent. But itís nowhere near the one in four AD/HD children that were originally proclaimed to be manic children. We donít quite know what the relationship is with bipolar disorder, but no follow-up study has ever found AD/HD children prone to bipolar illness, and the largest study ever done of AD/HD children, just published this past year [1999] known as the MTA study ( cfm), also found no higher incidence of bipolar disorder. But I would be generous enough to say maybe 1-6 percent".

09-30-05, 08:56 AM
Scuro, I have a question for you, if you don't mind. My son was diagnosed with ADHD/ODD/IED, but are those symptoms included with bipolar? My question is, how do you distinguish bipolar, from ADHD?

09-30-05, 10:19 AM
I believe what he (Barkley) said at Door County was along the lines of 1-6% (2-7% max).

It certainly appears to be over diagnosed and I have my concerns about that. At the same time tho, that's strictly anecdotal.

Over the years, I have worked with a number of children who clearly have a bipolar disorder.

Their behaviors were so pronounced that there was little doubt about the disgnosis.

Not all of them were diagnosed from the "get go," so to speak, as ADHD is almost always seen first.

At some point tho, you knew there was much more going on.

It's a tough call and I try to be as conservative as possible.

Thank you for raising these very important questions.

09-30-05, 12:11 PM
It can happen. A friend of mine daughter was diagnosed with bipolar. She was doing drugs, cutting herself and sleeping around. She was treated for bipolar and was miserable. Once she came visit her dad and I convinced her to see a doctor here my son goes too. The doctor was alarmed at all the meds the girl was on and took her off everything except an antidepressant. She is soooo much better now! Her new diagnoses was ADD, depression and social anxiety. She doesn't take anything for ADD as it aggravates her anxiety too much.

Sad thing is she never finished high school. I suspect her mother incouraged it in order to get one more year of child support. :mad:

09-30-05, 06:30 PM
...It's a tough call and I try to be as conservative as possible...

That is the way it should be. Interesting...I had never even thought of the drug angle. Wouldn't someone who abused stimulants look BiP? I'd worry also about ADHD/Conduct disorder, or say PTSD as possible false negatives for a BiP diagnosis.

In looking at the criteria for a looks like you would have to see evidence of a manic phase because the behaviours in a manic phase seem to be what really lets you tell the two disorders apart. How would you go about measuring these behaviours, the challenge would be that the behaviours could be episodic and you may not see them for a while.

09-30-05, 06:37 PM
You'd have a tougher time of it.

Probably the best overall way would be to try and get some type of longitudinal viewpoint.

Someone who was truly bipolar would exhibit mood swings on a regular basis over time.

If the only time a person ever showed mood swings is while using, that would help sort it out.

I've often said that making accurate psychiatric diagnoses is like putting a puzzle together in the dark.

09-30-05, 06:51 PM
You'd have a tougher time of it.

Someone who was truly bipolar would exhibit mood swings on a regular basis over time.

If the only time a person ever showed mood swings is while using, that would help sort it out.

I guess it would be even harder because BiP mood swings in children change frequently and are not predictable.

And the thing about drug use is, that no kid is going to tell you that they are abusing drugs.

So I guess it's more like putting a puzzle together, in the dark, while blindfolded. :)

09-30-05, 09:12 PM
When a bipolar child is cycling he/she is uncontrolable. They'll just start to scream, run, cry, hit themselves or others all at the same time. Look in their eyes they be glazed over. Talking in them in a soft voice, telling them you love them and it's okay to be upset, may calm them down. This is just my opinion I would love to talk to others who have bipolar children.

10-20-05, 09:27 AM
My son was just diagnosed with BP, he had been giving stimulants to treat ADHD which was diagnosed first he has now had to be taken off of them because the stimulants have a history of causing their mood swings even harsher than they are. In my son the stimulants would cause major rages daily, he would go after other children, kick walls, scream, and even if you were telling him what he wanted to hear. He has started a mood stabilizer now and will again be treated for the ADHD once the BP medication is undercontrol. This is my experince with stiumlant medication with my son.

10-20-05, 10:34 AM
I'm not adhd, never diagnosed with it either. I am however dx'd BP1 (that's the really crazy one :D ) In retrospect I can tell you symptoms that I exibited when I was young.

Depressed, crying, over emotional wanted to die one day and over the top hyper the next. This was as early as 7 years old is when i can remember. Everyone said I was just "sensitive". It just got worse as I got older, teens brought drug and alcohol use and lots of permiscuity.

I think the reason they can look so similar is the mania can appear to someone as being clasically hyper active in children. My son is dx'd with adhd and fortunetly his doctor didn't automatically assume that since I have BP that my son does too. His symptoms are very different than mine. He get's angry at times but it's not the same as depressed. I tend to think that one of the biggest differences is the depression. Can you imagine an adder not getting out of bed for days ?!?!? There is no doubt in my mind that my son is add not BP and the first time a dr tells me that is the last time we see them.

:soapbox: All parents should watch for depression in their kids whether they are 5 or 18. It's very scary and very critical to get the help they need immediately. Depression is a potentially life threatening illness and the sooner people realize that and treat it as such the better that persons life will be. My parents didn't for whatever reason and I didn't get any help until I was an adult. When I did it was always for the depression - no one picked up the BP until I was 36 years old. Not a pleasant life until then. Medication for any MI is essential even if they aren't that fun to take. Quality of life can be determined in those very young years. Pay attention to your kids! If they truely are BP mood stabalizers are a saviour. For close to 2 years now I have had a fairly stable life.