The Difficulty of Diagnosing ADHD and Bipolar Disorder in Children

Written by Anne Brown

Misdiagnosing ADHD and bipolar disorder in children is not unusual. Find out why along with detailed information on ADHD and bipolar disorder in young children.

In children, attention deficit hyperactivity disorder (ADHD) and bipolar disorder are often misdiagnosed due to an overlapping of symptoms like inattention and hyperactivity. If left untreated, these children are at risk for developing antisocial behavior, social alienation, academic failure, along with problems with the law and substance abuse. Correct diagnosis and early intervention are the keys to improving the outcome for these children.

ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed childhood psychiatric illness, affecting about 345% of American children under the age of 13. Children with ADHD do not appear to have a deficit of attention so much as a lack of consistent direction and control. Two symptoms commonly identified with ADHD, impulsivity and hyperactivity, are not required for the diagnosis.

There are strong gender differences in ADHD - nearly 90% of children diagnosed with ADHD are boys. Differences in how boys and girls exhibit symptoms may play a role in the prevalence of ADHD in boys. Boys with ADHD are more likely to be hyperactive than girls and, therefore attract a great deal of attention. A girl with ADHD who daydreams at the back of a classroom may be unhappy and failing in school, but she does not attract the attention given to a boy who is constantly talking out of turn, jumping up from his desk, and pestering other children.

Physical and psychiatric illnesses can cause symptoms that resemble ADHD. These include:

• atypical depression
• anxiety disorder
• impaired speech or hearing
• mild retardation
• traumatic stress reaction

A third to a half of children with ADHD have major depression or anxiety disorders. They may also have learning disabilities with deficits in visual and auditory discrimination, reading, writing, or language development.

Often, ADHD is associated with a conduct disorder (lying, cheating, bullying, setting fires, deliberate cruelty, etc.). It has generally been believed that the stimulant drugs used to treat attention deficits have no direct effect on this misbehavior. A recent study, however, found that the stimulant methylphenidate (Ritalin) improved unpleasant behavior of all kinds - even cheating and stealing - regardless of the severity of the child's attention deficit.

Course of Illness

ADHD in adolescents varies more than in children and is marked by poor follow-through on tasks and failure to complete independent academic work. The ADHD adolescent is more likely to be restless than hyperactive, and engage in risky behaviors. They are at increased risk for school failure, poor social relationships, auto accidents, delinquency, substance abuse and poor vocational outcome.

In about 10-60% of the cases, ADHD can persist into adulthood. A diagnosis of ADHD in adults can only be made with a clear history of childhood attention deficit and distractibility, impulsivity or motor restlessness. ADHD does not have a new onset at adulthood, therefore an adult must have a childhood history of ADHD symptoms.

Objective Test for ADHD

Research studies are being done to more easily identify children with ADHD. Dr. Martin Teicher, of Harvard University, has developed an infrared motion analysis system to record the movement patterns of boys with ADHD and normal controls as they performed a repetitious attention task seated before a computer. The system tracked the position of four markers placed on each of the boys' head, back, shoulder, and elbow, at 50 times per second with a high degree of resolution.

The test results showed that the boys with ADHD were two to three times more active than normal boys their own age and had larger whole body movements. "What this test measures is a youngster's capacity to sit still," said Dr. Teicher. "There are a lot of children who know they should sit still and have the capacity to sit still, but just don't. This test is able to detect the children who know they should sit still and try to sit still, but physically are unable."

A child's capacity to sit still, said Dr. Teicher, often distinguishes a child with ADHD from a child who may have a simple behavioral problem, neurological problem or learning disorder. "It surprises me how often clinicians say ADHD, when the problem is really a learning disorder; particularly when there is no evidence of ADHD and no evidence that medications help learning disorders," he noted. This test, known as the "McLean test," uses recent advances in video technology to accurately measure both attention and body movements, unlike previous tests which have focused entirely on attention as an indicator for ADHD.