Clinical diagnosticians have sometimes struggled in their attempts to distinguish between childhood bipolar disorder and ADHD. There are a number of similarities in the two conditions but if diagnosis is incorrect the treatment subsequently prescribed may be ineffective or possibly even damaging.
Bipolar disorder in children is less marked than in adults. Unlike the swings in mood that typify adult bipolar disorder, children may exhibit general irritability, grumpiness and be occasionally hot-tempered. ADHD is characterized by inattention, impulsive behavior and hyperactivity. ADHD is a chronic condition whereas childhood bipolar disorder is interspersed with periods of normal mood.
The standard approach to diagnosis is via questionnaires, interviews with parents and use of behavior rating scales. This is part of the problem as it can be quite difficult to distinguish between the two disorders using behavioral measures.
Recent news from the University of Illinois at Chicago points to brain imaging as a way to identify differences. Researchers used functional magnetic resonance imaging to examine the brains of children with bipolar and ADHD as they undertook a simple memory task. Children were asked to view a variety of facial expressions (happy, sad, angry) and to press a button if they saw the same face repeated.
Researchers found that children with ADHD showed greater dysfunction in an area of the brain known as the prefrontal cortex. By contrast, the children with bipolar disorder showed more deficits in regions of the brain associated with emotion-processing and regulation.
Assistant professor of psychiatry and lead author of the study Dr. Alessandra Passarotti, told the online journal Sciencedaily that the long-term goal is to develop diagnostic tests based on both neurological and behavioral markers of the illnesses so that it becomes easier for clinicians to develop more accurate diagnoses and better targeted treatments.
The problem of misdiagnosis for children with bipolar disorder is if you give them a stimulant, they show more pronounced symptoms and the illness becomes worse. Equally, if a child with ADHD is misdiagnosed, the use of mood stabilizing medication will result in no behavioral improvement.
Until the process becomes more refined and subsequently more widely available, existing diagnostic practices remain. Parents meanwhile are naturally concerned that their children receive proper diagnosis and treatment. The website WebMD, suggests the following:
- Ask how the diagnosis was made.
- Make sure the doctor talked with the child's teachers or had written reports from teachers.
- Be sure the doctor evaluates the child over a period of time, not just from one visit.
- Review all of the information that went into making the diagnosis of ADHD or bipolar disorder.
- Before deciding on treatment, consult an expert in child and adolescent psychiatry for a second opinion.
- Make sure the doctor sees the child frequently after the diagnosis is made to check the medication for effectiveness and side effects.
Alessandra M. Passarotti, John A. Sweeney, Mani N. Pavuluri. Emotion Processing Influences Working Memory Circuits in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 49, Issue 10, Pages 1064-1080 (October 2010) DOI: 10.1016/j.jaac.2010.07.009
Bipolar Disorder or ADHD." WebMD.com. N.p., 25 09 2008. Web. 18 Oct 2010. <http://www.webmd.com/add-adhd/guide/bipolar_disorder_or_adhd>.
University of Illinois at Chicago (2010, October 12). Brain imaging identifies differences in childhood bipolar disorder, ADHD. ScienceDaily. Retrieved October 18, 2010, from http://www.sciencedaily.com /releases/2010/10/101012151236.htm
Published On: October 18, 2010
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