Irritability, hyperactivity, restlessness, impulsiveness, extremely high energy and oppositional attitude are symptoms exhibited by children with attention deficit hyperactive disorder (ADHD) that are also exhibited by children with bipolar disorder (BD). These symptoms overlap both, which can be confusing to parents and professionals alike. But ADHD children are easily distracted. They may get angry but rage is rare, and symptoms do not come and go. With supervision their behavior can be redirected and moods seem to occur appropriately.
Just like children with ADHD, bipolar children are frequently extremely sensitive to artificial colors, flavors and preservatives in food. They may also have coexisting celiac disease. There are natural treatments for bipolar disorder; some of these may lessen symptoms in children.
Bipolar Children Have More Severe Problems
Severe mood swings in bipolar children typically occur very rapidly. They may appear elated; their speech is rapid, continuous, and grandiose at times. Tantrums, aggression, and rage may be problematic. Bipolar children are more likely to engage in risky behaviors. They may sleep little and have an inappropriate interest in sex. Separation anxiety, disinterest in activities and bouts of crying may also occur. Suicidal ideations should be taken seriously. Parents should report any indications that a child may harm himself to a mental health professional or community hotline.
An Unexpected Response to ADHD Treatment is a Clue
A child who is diagnosed with ADHD and given stimulants or antidepressants may bounce off the walls or become suicidal if there is undiagnosed bipolar disorder at work. Mania, rage, depression or insomnia will typically become worse. No response to ADHD treatment may also signal underlying BD.
Normal development, such as mood swings in adolescents, and appropriate play behaviors might look like BD symptoms and must be carefully assessed. A healthy child is not grandiose when imitating a superhero. The characteristics of bipolar disorder are pervasive and impairing. Risk for self-harm and potential for abuse and neglect are important components of assessment.
Symptoms of Bipolar Disorder Vary With Age
Most cases of childhood BD are identified after age seven, when elevated mood and irritability are likely to be pronounced. Younger children are more prone to symptoms of restlessness and agitation. There is no blood test for bipolar disorder. Diagnosis is made by symptoms and cannot be pinned down based on a single evaluation. Data should be collected from parents, teachers, and other caregivers. The mental health professional's personal interaction, observation and assessment are important.
Children can often answer questions about how they feel; statements such as “nobody likes me” or ‘I'm stupid” can signal depression. Treatment should follow a clear rationale, but it is not an exact science and frequent reassessment and treatment plan updates are expected.
Bipolar Disorder May be Familial
A diagnosis of mental illness in a child can be devastating, regardless of whether or not the disorder affects other family members. The trial-and-error nature of treatment adds to frustration and stress, as does misunderstanding and stigma. Parents need to feel confident, competent, and assured that their parenting style is not at fault. They should also realize that their children are not “out to get them” in any way. Parents need support to avoid feeling overwhelmed.
The complex presentation of childhood bipolar disorder confuses even mental health professionals. Some characteristics overlap, but others, along with reactions to medications and professional assessment, can help determine the differences between BD, ADHD, and normal childhood behavior.