View Full Version : Can ADD be Intermittent or Cyclical?


RobK
07-03-09, 12:09 AM
We've been having problems with my 13yo son since he was 7. He saw/sees a psycholgist and psychiatrist. The psychologist and previous psychiatrist never clearly diagnosed my son with ADD. In fact the psychologist said he really doesn't fit the ADD mold, though he does appear to suffer from some form of depression. The new psychiatrist (the previous one left the practice) seems pretty confident that my son has ADD.

My son has gone through periods (1-3 months) where he can be irratable, uncooperative, and subject to explosive rage; typically over something trivial. Needless to say his grades also slip because he won't complete assignments, etc. However, at times within that 1-3 months he can be the most happy, loving, focused individual imaginable. These 1-3 month periods are typically separated by longer periods (2 months to 2 years) where he is essentially normal; very good grades, few behavioral problems, etc. He does take Prozac, and now Vyvanse has replaced the Adderal.

I know many other kids who've been diagnosed as ADD, and they tend to be very consistant. It's also very obvious when they don't take their medication. I see no difference in my son on the Adderal/Vyvanse or off. I'm certainly not against a diagnosis of ADD, but I don't think it fits my son. I think he has other problems that are not yet being adequately addressed. So the question to the forum is, does anybody else parent a child who's ADD cycles on and off over extended periods? I greatly appreciate your thoughts.

Rob

Lady Lark
07-03-09, 12:35 PM
Someone who is ADD is always ADD. They might have better days, or worse days, but it's always on. In fact, having it effect more then one aspect of your life is part of the criteria for diagnosis.

The first thing I always think of when someone mentions how their kid cycles is bi-polar. Have you looked into that at all?

wifeandmom
07-03-09, 12:48 PM
I agree with Lady Lark; my first thought would be Bi-Polar Disorder. Here's an article from ADDitude Magazine that discusses the differences and similarities between Bi-Polar and ADHD:

http://www.additudemag.com/adhd/article/2511.html

speedo
07-03-09, 01:01 PM
I agree with the others. You either have adhd full time or you don't have it at all. Cyclic depression and mania sounds a lot more like bipolar disorder to me. In a young child it is hard to tell for sure but you might want to look into bipolar disorder if you have not done so yet.

Oh... and people who have bipolar disorder typically have the symptoms of adhd. In fact many (most?) people with bipolar disorder could be said to have adhd as well....and quite a few are treated for adhd along with their bipolar.

People with adhd are scattered because they cannot control attention. People with bipolar appear scattered because they have flights of ideas. The difference is subtle, but is a difference...unless of course, you have both adhd and bipolar, then you simply have symptoms of both.


good luck
Me :D

RobK
07-03-09, 03:24 PM
We ruled out bipolar a few years ago. He doesn't have the manic phases you would expect with bipolar. The rest of the time he's just pretty normal. Also, when you put someone who is bipolar on an antidpressent (he's on Prozac) you would expect it to exacerbate the mania. That hasn't happened. I think his problem is depression with additional anger issues. I just don't see the ADD which doesn't explain the cycles. Last year in 6th grade, we never once looked at his homework. He's was in all advanced classes, and had all As and Bs. I guess I just don't want him treated for ADD if that is not the problem.

Lady Lark
07-03-09, 03:58 PM
The problem with ADD and other similar issues is that they have so many overlapping symptoms that it's sometimes hard to get the correct diagnosis. Symptoms are the same, but caused by different means.

Has he had a full mental evaluation before or have they been just evaluating to see if he has X? It makes a difference. Is the psyc that he sees a pediatric? Since it's so much fuzzier when dealing with kids, it's always best to see someone who specializes in children, if possible.

As for antidepressants making mania worse, that's not always the case. My sister was treated for just depression for several years before they nailed down it was really bi-polar. He manic episodes weren't made worse by the antidepressants she was on.

Bottom line, if you don't think it's ADD, then I would suggest yo get another opinion. It doesn't help to treat something that he doesn't have. (if that's the case)

RobK
07-03-09, 04:08 PM
Agreed, that nothing is 100% definitive with kids or psychology, but that is why I'm asking questions. It sounds like ADD is not typically a on-again, off-again kind of thing. That is why I'm not comfortable with the diagnosis.

KDLMaj
07-03-09, 06:59 PM
Children who are manic don't tend to experience euphoria- instead they have what is termed "mixed episodes"- they become incredibly irritable and often demonstrate symptoms of depression simultaneously. Also, SSRIs often successfully treat mixed episodes in children. It may well be that your child spends most of their time depressed, and when the hypomania hits- that's when they have the mixed episode symptoms. That would be consistent with pediatric bipolar disorder type II. So that one is out too. A quick and dirty check is:

1. During these episodes of his, does he suddenly show far less interest in sleep? Is he up at all hours and yet shows no signs of sleep deprivation the next morning?
2. During these episodes, does his appetite suddenly decrease?

ADHD is not cyclic in the manner you are describing. Pediatric bipolar disorder sounds more reasonable, but you want to be sure you take him to a psychiatrist who has experience in children with bipolar disorder. Any doctor who tells you they don't seem to show standard mania and therefore aren't bipolar likely doesn't know the differences between adult and adolescent presentation.

However, barring that, there would be a number of other explanations ranging from thyroid issues (which can be cyclic) to particular allergies. ODD is also possible, but it doesn't tend to be cyclic in the manner you're discussing.

Justtess
07-03-09, 07:19 PM
RobK,

Have you tried interviewing other psychiatrists and psychologist who specialize in adolescents? I had to go through a handful before I found one I was confortable with a proper dianosis. There must have been 3-4 other psychiatrists and psychologists who would recommend medication with a possible w/reservation diagnosis.

When my son hit 15, the hormones changed a lot of behavior for my son. I saw him fustratingly trying to manage his emotions and there other behaviors I found difficult to address with him... anger being the main concern.

I had thought he may have been starting to become bipolar however, when I looked over overexcitability issues... he tended to fit this model. His doctor switched him from a mood stabilizer (abilify) to Tennex which did wonders.

RobK
07-03-09, 07:53 PM
The psych gave us the name of a new counselor who specializes in anger management in adolescents. That's the next step.

speedo
07-03-09, 08:08 PM
Not only is adhd not typically cyclic, it is not ever cyclic.

Me :D


Agreed, that nothing is 100% definitive with kids or psychology, but that is why I'm asking questions. It sounds like ADD is not typically a on-again, off-again kind of thing. That is why I'm not comfortable with the diagnosis.

wifeandmom
07-03-09, 08:41 PM
When DD was being evaluated at about age 7, we went through multiple med trials with unsatisfactory results. Her psychiatrist was the best we've had in 11 years and we had confidence in her. After about the third med, we decided to try Ritalin (big stigma in the late '90's regarding Ritalin). Anyway, the pdoc said if Ritalin didn't work, we would have to consider Bi-Polar. She explained that pediatric BMD looks different because kids are typically rapid-cycling - often several times a day. There are many different presentations of Bi-Polar, just as there are ADHD.

mctavish23
07-03-09, 09:45 PM
It depends on how you "define" matters.

ADHD is 24/7.

However, one of the distinguishing characteristics is "variability (i.e.,inconsistency)."

That translates to "One day we get it, and the next day we don't."

When you throw in the ever evolving developmental nature of the disorder and how that

impacts the symptoms over time,as well as individual differences & degrees of severity,

it's clear that "One size doesn't fit all."

tc

mctavish23

(Robert)

Kunga Dorji
07-03-09, 10:47 PM
It depends on how you "define" matters.

ADHD is 24/7.

However, one of the distinguishing characteristics is "variability (i.e.,inconsistency)."

That translates to "One day we get it, and the next day we don't."

When you throw in the ever evolving developmental nature of the disorder and how that

impacts the symptoms over time,as well as individual differences & degrees of severity,

it's clear that "One size doesn't fit all."

tc

mctavish23

(Robert)

Another way too look at this is that apart form ADHD- there are other issues that cause inattention- most notably sleep deprivation, anxiety and depression. A level of ADHD may not be too much of a problem if everything else is coasting along OK. My daughter slipped badly on a couple of occasions when she had clashed with some other kids at school, and was not feeling tooo sure of herself. The same also happened when confronted with new units of work that she struggled with. Cyclic behaviour, non cyclic ADHD- but a very psychodynamic explanation for the behaviour fluctuations.

MGDAD
07-06-09, 11:40 AM
One important question is how those "explosive rages" happen. Can you reason at all with him during those times? If not, then that is a form of mania. Or as some describe it is actually closer to seizure. Once he gets angry he just cant stop.

You also cant diagnose someone based on their response to medications.

As noted before, a large percentage of people with bipolar, also have ADHD, but not all of them. If your son can get great grades and not be reminded to do his homework, that does not sound like ADHD. Or, maybe the medication is just working really well.

What behaviors are you trying to control with the Vyvanse?

Kunga Dorji
07-06-09, 05:44 PM
We've been having problems with my 13yo son since he was 7. He saw/sees a psycholgist and psychiatrist. The psychologist and previous psychiatrist never clearly diagnosed my son with ADD. In fact the psychologist said he really doesn't fit the ADD mold, though he does appear to suffer from some form of depression. The new psychiatrist (the previous one left the practice) seems pretty confident that my son has ADD.

My son has gone through periods (1-3 months) where he can be irratable, uncooperative, and subject to explosive rage; typically over something trivial. Needless to say his grades also slip because he won't complete assignments, etc. However, at times within that 1-3 months he can be the most happy, loving, focused individual imaginable. These 1-3 month periods are typically separated by longer periods (2 months to 2 years) where he is essentially normal; very good grades, few behavioral problems, etc. He does take Prozac, and now Vyvanse has replaced the Adderal.

I know many other kids who've been diagnosed as ADD, and they tend to be very consistant. It's also very obvious when they don't take their medication. I see no difference in my son on the Adderal/Vyvanse or off. I'm certainly not against a diagnosis of ADD, but I don't think it fits my son. I think he has other problems that are not yet being adequately addressed. So the question to the forum is, does anybody else parent a child who's ADD cycles on and off over extended periods? I greatly appreciate your thoughts.

Rob

Rob- looking at your post again I think that explosive rages are very common in ADHD but the non ADHD part is the ebb and flow of the moods over the longer term.

I'm having an ongoing argument with my psych- who was very much involved in improving the understanding of bipolar 20-30 years ago. He is inclined to see bipolar in everything. I am not so sure myself- I dont think we pay enough attention to individuals and their internal lives. We ADDers are really pretty resilient- and even when the going gets rough we work like mad to get on an even keel. Maybe the irritable periods represent periods of greater struggle for him- are there bullying issues at school or something like that?

I have become much more aware of my irritability since my son has started producing the same sort of behaviour- I note that both of us get into a sort of emotional gridlock- where something has got to give. I'm older now- and learning a few more skills- but it seems to me that we get into states where our emotional intelligence is not accessible to us. It is sort of tough getting a 14 yo (my son) to take the concept of emotional intelligence seriously- but I am trying! I am finding that it is best to take a very low key approach to his tempers, and to encourage him to express his issues as fully as he can- with confidence that he will be at least heard. He seems to be learning to avoid getting into such unbearable knots of frustration.