ADHD, Bipolar , or ODD Misdiagnosis and Crossover symptoms
by Andy's mom
We are in the process of having our child (7 years) evaluated for various disorders. He was just tested positive for sensory disorder (he seeks sensory stimuli) and that he is 2 years developmentally delayed.
The therapists and counselor is looking for one of the following: Bipolar, pervasive development, ADHD, and ODD. I know many of these disorders have cross over type symptoms. Are there any symptoms that would be seen in one and not the other?
In other words, what should I specifically be looking for to narrow the field of what we are looking for? I am mostly afraid of misdiagnosis and treatments for the wrong disorders.
His main symptoms are excess energy, anger management type issues (wants to "pay back" other children especially for making him angry) , unwillingness to cooperate in chores(etc.).
Hi Andy's mom
This is an extremely difficult question to answer. Understand that the actual criteria that currently exist for making these diagnoses are flawed, and most professionals are not trained to do this effectively. This is why you worry about misdiagnosis. If you want to know the specific criteria for each diagnosis, you can look up DSM criteria for ADHD, ODD and Bipolar Disorder.
I can talk with you about ADHD, ODD and Bipolar Disorder. PDD is not my area of expertise .
Bipolar Disorder is a mood disorder that until the late 90's was not thought to exist in children. We now know that it does exist in children,( although people will argue that it doesn't) and that it evolves and changes into a different looking illness over time. Bipolar Disorder in children does not look like Bipolar Disorder in adults.
In order to diagnosis Bipolar Disorder in a child, the current wisdom holds that they must exhibit distinct signs of mania, and signs of depression, both of which can be found detailed on my website. There are many symptoms that are associated with the two mood states mania and depression: irritability, anger, anxiety, energy fluctuation, and sleep disturbances to name a few.
Oppositional Defiant Disorder -like symptoms are often seen in a child with bipolar disorder, but they are part of the bipolar disorder not a separate diagnosis.
Bipolar children can have symptoms of oppositional behavior mostly during mood states, this does not make them ODD. To say this simply, a child with bipolar only exhibits oppositional behavior at certain times( i.e. when they are manic) , whereas a child with ODD always exhibits these behaviors. These behaviors are negative and hostile and consist of arguing, refusing to comply, blaming others, or behaving in a spiteful, angry, vindictive way.
Children who only have ODD behave in a negative and hostile way, but don't have the fluctuation in their symptoms that kids with bipolar have. These children also don’t have all the other symptoms of bipolar disorder.
Children who have ADHD, who do not have bipolar, do not exhibit swings between depression and mania. They exhibit problems with their attention and impulsivity. Children who have bipolar disorder but not ADHD may exhibit disruption in their attention and impulsivity when in certain mood states.Many children with bipolar disorder also have ADHD.
Children can have all of these diagnosis, or any combination therof. See how complicated this is?
The symptoms need to be studied in the context of a carefully constructed developmental history in order to get the most accurate diagnosis.
Family history is extremely important during this process. If there is bipolar disorder in the family, this is something I would be looking for as a possibility.
Misdiagnosis can be catastrophic because ADHD medications make bipolar children worse, and perhaps permanently worse. It is also a problem if you are treating a child with bipolar as if they have ODD, because treatment for a bipolar child consists of determining their mood states and modifying their environment based on that. ODD treatment is more behaviorally based, and will be unsuccessful with a Bipolar child.
I hope this has been helpful for you.
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