I think often what is called ADHD is actually bipolar, which is why the kids don't improve. Also, a very common thing is for high functioning autism to be mistaken for ADHD. That may even happen more than bipolar. At any rate, if ADHD is too severe to be ADHD, it probably isn't. If it walks like a duck...
More importantly parents need to know that kids with both bipolar and ASD usually meet the criteria for ADHD, but that doesn't mean they have it, or that this is all they have. Stimulants, in the wrong body, can be dangerous. They only help those with actual ADHD.
Dr. Papalos is the author of "The Bipolar Child" and a renowned Psychiatrist. This is just a short blub of the whole article, but it think it tells a lot.
particular mood may last only an hour or even minutes.
In response to a question from a child psychologist in Kansas, received by e-mail, Dr. Papolos explains some of the ways that a mental health professional can differentiate between bipolar disorder and Attention Deficity Hyperactivity Disorder. Among them, he says, are the rapid fluctuations in mood mentioned above, as well as rages that last more than a half an hour (and can last up to seven hours). Particularly telling in their study, he says, was a clear family history of mood disorders and/or alcoholism, pointing to the importance of taking a careful family history before arriving at a diagnosis.
Misdiagnosis carries a tremendous risk, Dr. Papolos noted, as the stimulants and anti-depressants often administered for ADHD and depression can have terrible consequences for bipolar kids. In the Papolos' study, 65 percent of kids exposed to stimulants had serious adverse effects. They can become manic, violent and psychotic enough to require hospitalization on stimulants, and react even worse when placed on antidepressants.
Since the stakes are so high, says Janice Papolos, the standard should be to rule out bipolar disorder before writing any prescriptions. She points out that 94 percent of bipolar kids will meet the criteria for ADHD. In addition, while suicide is always a risk with bipolar disorder, Dr. Papolos says, it's even a higher risk when kids are exposed to stimulants and antidepressants. Kids will sometimes become grandiose in their mania and think they can fly, and try to jump out of a window or out of a moving car.
So what gets in the way of a correct diagnosis? Dr. Papolos says he believes the largest single obstacle to treatment are the current diagnostic manuals used by clinicians. The American Psychiatric Association's DSM-IV, for example, requires that childhood bipolar disorder fulfill the same criteria as adult bipolar. This is reinforced by a pervasive myth that's been drilled into mental health professionals that bipolar disorder does not occur before adolescence, he says. It would be more useful and accurate, he says, to urge professionals to inquire about rapid mood swings within the course of a day, as opposed to whether there manic symptoms last more than a week.
I have a four year old that was recently diagnosed with bipolar. We also went through the whole misdiagnosed thing. He was put on several stimulant medications before realizing that they only made him worse. He is now taking a few different mood stabilizing medication which is working magic on him. But like everything else the meds are not enough. He goes to therpy once a week has a TA who comes to our house once a week and sees psychatrist once a month. We also have an impact worker which works great to keep everything in line. The best advice that I think works great is the schedule and routine for kids with both adhd and bipolar. I run my house like a daycare having two boys with diabilites one with adhd and one with bipolar and it works wonders at least for my son with bipolar.