I have a 6 year old son, who was diagnosed at age 3 with ADHD (We took him to a psychologist after he was nearly thrown out of Head Start for violent behavior). He was put on Adderall and Risperdal, and seemed to be doing okay. Over the last few months, however, he has been getting more and more violent. At his most recent trip to the Psychiatrist, his Adderall and Risperdal were both upped---he subsequently got even more violent. The meds were reduced again, but even though his aggression briefly dropped some, it has skyrocketed over the last couple of weeks. The day before yesterday, I had to hospitalize him. I feel horrible. The psychiatrist there says she thinks he may be bi-polar. How can I know for sure what is wrong with him?:confused:

I do not know the answer. However, it seems that children get misdiagnosed frequently. Many of the dissorders have overlapping symptoms, so it can be difficult to define which dissorder applies, and often it is multiple dissorders. To me, the big 3 dissorders are ADHD, Autism and Bipolar. Here is an excellent link about Autism. Note that some of the disorders described are not in the DSM.

http://www.pediatricneurology.com/autism.htm

I think if meds for ADHD do not help the problems that could be an indication that he is not ADHD. Or, at a minimum (obviously) that it is the wrong medication for him. It is hard to know what is the best med for each child.

I'm so sorry this happened.

Even if he is not misdiagnosed, bipolar disorder is commonly comorbid (I have both). If they determine that he is bipolar, it's very treatable.

Hang in there!

Oh, and on the topic -- these scans have been studied pretty extensively in recent months and the results suggest a scam, or at best misguided faith.

mmelissab,

I can't answer specific questions, as I don't/won't practice on the net.

However, I can discuss issues in general.

If you go to the Bipolar section, you'll see some great posts/reprints that Andi has found.

One of those is covered in a CD I listened to for CEU's.

The research study being discussed points out is that there is a "One-way comorbidity" between Bipolar and ADHD.

What that means is the 90+% (I've seen 92% & 97% referenced) of kids with Bipolar, also have ADHD;while the reverse isn't true.

As I'm sure you know, there's no exact test for ADHD and even less so for Bipolar.

However, the research in question did determine the following 5 behaviors to accurately discern one from the other.

The evidenced based (research substantiated) differences between Bipolar kids w/ADHD vs ADHD only are:

1) elevated moods (the duration of which determines the type of Bipolar)

A child with ADHD won't have the types of (severe/lenghty/destructive) mood swings associated with Bipolar.

Another way to put that would be the ADHD (only) kid would have situational mood swings perhaps related to some trigger like being told "No," while the Bipolar kid (who has a 90+% chance of also having ADHD) can start cycling for no apparent reason.


2) decreased need for sleep

Bipolar kids can get by with as little as 2-3 hrs sleep and then wake up still full of energy.

ADHD (only) kids are reported to be very crabby in the morning and can't get by on that little amount of sleep.

3) flight of ideas (racing thoughts)

Bipolar kids minds don't "shut off," while an ADHD only kid would present as having trouble focusing/concentrating.

Their speech would also not reflect too amny ideas trying to get out of the child's mouth at once.

4) grandiosity- the Bipolar kid is the world's leading expert on everything and usually will be intrusive in telling or showing you why.

5) hypersexual behavior (at an early age)-this is NOT related to child abuse. What it refers to is a young Bipolar child being overly sexually precocious for their age.

There's also a 6th (anecdotal) difference, meaning research hasn't supported it, that comes up at every workshop I've ever been to on the subject, and that is Extreme destructiveness.

I hope that helps you.

This list triggered a warning for me -- to keep in mind that, like with ADHD, people do not usually exhibit ALL of the symptoms, so don't think you're off track if one doesn't fit. For example, I'm bipolar and:


The evidenced based (research substantiated) differences between Bipolar kids w/ADHD vs ADHD only are:

2) decreased need for sleep

Bipolar kids can get by with as little as 2-3 hrs sleep and then wake up still full of energy.

ADHD (only) kids are reported to be very crabby in the morning and can't get by on that little amount of sleep.
This doesn't describe me at any point in my life! Even when mania cuts into my need for sleep by a few hours, I still wake up CRABBY!!!


3) flight of ideas (racing thoughts)

Bipolar kids minds don't "shut off," while an ADHD only kid would present as having trouble focusing/concentrating.

Their speech would also not reflect too amny ideas trying to get out of the child's mouth at once.

This is only during "up" phases. During "downs" the child might speak very little. Up phases don't have to be happy; these are also times you might see rage or violence.



4) grandiosity- the Bipolar kid is the world's leading expert on everything and usually will be intrusive in telling or showing you why.

Okay, this totally fits me. Evidence: this post.

lol....no comment:)

The Doc gave MORE Adderall [stimulant med] to a child who has become increasingly violent and needed Risperdal [antipsychotic med] after initially starting the loading dose of Adderall?

Stimulants can cause psychosis in some people. This is really not sounding good.

Was this a child psychiatrist?

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BTW, IIRC, it can be VERY difficult to sort out some cases of extreme ADHD (featuring severe hyperactivity), Bipolar and other types of Psychosis, in childhood.

'Differential diagnosis' of Young Children is a HUGE challenge that way, I understand.

I was one of those children a was dx'd ADHD hyperactive/impulsive type at the age of 5 and at about 9 years old I became a "mood cycler" and at age 11 they stopped all of my ADHD treatment (i.e. dexedrine, which i exhibited an extremely positive response to and do again to this day) and the educational aspects and my life went to hell, as a "coping mechanism" due to the "hyperactivity on the motor function to be exact and the triggered mood swings getting worse and escalating to cycling regardless of the Depakote/Lithium and Trilafon" I was not one who would take meds purposely so I could have that "mania level extreme intelligence" IQ is 158... and that was how I fluctuated in school between Grades that were straight a's to d's and f's noting that d's and f's were present in what was to believed to be "hypomania". I'm glad that at 24 I can assess my development although I resent the psychiatrists I used to see because they believed that Bipolar and adhd couldn't occur together. And until recently that Has been the belief that has been "in stone" for awhile. If he is actually bipolar and ADHD once the mood is stabilized (which judging by his med combo i would assume that is what is being assessed) it will not interfere with his "mood cycling" to add a treatment of a stimulant but better the overall as a whole. I am glad that I can slow down all of this fidgettyness and energy and lack of focus and self control now because letting the adhd part of his diagnosis go left untreated, speaking from personal experience... it will ruin his life and he will be full of disappointment with a mood stabilizer alone... like i often was.

I'm very sorry your family is going through this -- it's always hard to see our children struggling. The information already given is excellent -- one further question that came to mind, is there any bipolar in your family? This tends to be a very heritable condition.

Take care and let us know how it goes!
Scattered