Differentiating Between ADHD and Bipolar Disorder in Children

52 Pages·2013·1.82 MB·English

by  Geoff Zeger

Differentiating Between ADHD and
Bipolar Disorder in Children

NAMI-NC Eastern Regional Conference
Saturday, February 25, 2012

Geoffrey Zeger, ACSW,
LCSW
WHAT WE WILL COVER…

Take home points

Review Diagnostic Criterion for ADHD and BPD

Specific signs and symptoms that indicate one

vs. the other
Treatment (Medications, Therapy, Skill

Development, Parent Training, Structure, CBT,
DBT)
School (504 vs. IEP)

TAKE HOME POINTS…

ADHD is an Attention phenomenon requiring

strategies to structure behavior and channel attention
Bipolar Disorder is a Mood phenomenon requiring

strategies to help modulate mood and channel mood-
based-behavior
15% of U.S. children diagnosed with ADHD may

actually be suffering early-onset Bipolar Disorder
instead
Over 80% of children with a Bipolar Disorder will meet

full criteria for attention-deficit disorder with
hyperactivity, ADHD should be diagnosed only after
Bipolar Disorder is ruled out
TAKE HOME POINTS…
Stimulants unopposed by a mood stabilizer can

have an adverse effect on the bipolar condition.
65% of the children in one study had

hypomanic, manic and aggressive reactions to
stimulant medications
Suicidality, violence and mania caused by

selective serotonin reuptake inhibitors (SSRIs)
TAKE HOME POINTS…
When it occurs in childhood or adolescence it can
completely disrupt the life of the family. Bipolar disorder
that's undiagnosed, misdiagnosed, or poorly treated is
associated with:

increased rates of suicide attempts and completions

poorer academic performances

distressed relationships

increased rates of substance abuse

multiple hospitalizations

WHY DIAGNOSE……
Diagnosis
Assessment Intervention
ADHD DIAGNOSTIC CRITERION
SIX (OR MORE) OF EITHER 1) INATTENTION, OR 2) HYPERACTIVITY/IMPULSIVITY SYMPTOMS
MUST HAVE PERSISTED FOR AT LEAST 6 MONTHS TO A DEGREE THAT IS MALADAPTIVE AND
INCONSISTENT WITH DEVELOPMENTAL LEVEL, SOME SYMPTOMS CAUSING IMPAIRMENT WERE PRESENT
BEFORE AGE 7:

1) Inattention
2) Hyperactivity/Impulsivity

often fails to give close attention to details or

Hyperactivity
makes careless mistakes in homework, work, or
other activities often fidgets with hands or feet or squirms in seat

often has difficulties sustaining attention in
 often leaves seat in classroom or in other

tasks or play activities
situations in which remaining seated is expected
often does not seem to listen when spoken to

often runs about or climbs excessively in situations
directly 
in which it is inappropriate (in adolescents or
often does not follow through instructions and

fails to finish schoolwork, chores, or duties in the adults, may be limited to subjective feelings of
workplace (not due to oppositional behavior or
restlessness)
failure to understand instructions)
often has difficulty playing or engaging in leisure

often has difficulties organizing tasks and

activities quietly
activities
often avoids, dislikes or is reluctant to engage in is often "on the go" or often acts as if "driven by a
 
tasks that require sustained mental efforts
motor"
often loses things necessary for tasks or

often talks excessively

activities (e.g. toys, school assignments, pencils,
books) Impulsivity
is often easily distracted by extraneous stimuli
 often blurts out answers before questions have

is often forgetful in daily activities
 been completed

often has difficulty awaiting turn

often interrupt or intrudes on others (e.g. butts into

conversations or games)
BPD DIAGNOSTIC CRITERION
THE ESSENTIAL FEATURE OF BIPOLAR I DISORDER IS A CLINICAL COURSE THAT IS
CHARACTERIZED BY THE OCCURRENCE OF ONE OR MORE MANIC EPISODES OR MIXED
EPISODES.

Criteria for Manic Episode
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at
least 1 week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted
(four if the mood is only irritable) and have been present to a significant degree:
inflated self-esteem or grandiosity


decreased need for sleep (e.g., feels rested after only 3 hours of sleep)


more talkative than usual or pressure to keep talking


flight of ideas or subjective experience that thoughts are racing


distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)


increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor

agitation

excessive involvement in pleasurable activities that have a high potential for painful

consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish
business investments)
CRITERIA FOR MAJOR DEPRESSIVE EPISODE
Criteria for Major Depressive Episode
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or

observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood.

markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either

subjective account or observation made by others)

significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease

or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

insomnia or hypersomnia nearly every day


psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or

being slowed down)

fatigue or loss of energy nearly every day


feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-

reproach or guilt about being sick)

diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by

others)

recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a

specific plan for committing suicide
BIPOLAR SPECTRUM -
QUALIFIERS (MOST RECENT EPISODE,
SEVERITY, WITH OR WITHOUT PSYCHOTIC FEATURES)
296.4 Bipolar I Disorder, Most Recent Episode Manic, Unspecified
296.80 Bipolar Disorder NOS
296.66 Bipolar I Disorder, Most Recent Episode Mixed, In Full
296.56 Bipolar I Disorder, Most Recent Episode Depressed, In Full
Remission
Remission
296.65 Bipolar I Disorder, Most Recent Episode Mixed, In Partial
296.55 Bipolar I Disorder, Most Recent Episode Depressed, In
Remission
Partial Remission
296.61 Bipolar I Disorder, Most Recent Episode Mixed, Mild
296.51 Bipolar I Disorder, Most Recent Episode Depressed, Mild
296.62Bipolar I Disorder, Most Recent Episode Mixed,
296.52 Bipolar I Disorder, Most Recent Episode Depressed,
Moderate
Moderate
296.64 Bipolar I Disorder, Most Recent Episode Mixed, Severe With
296.54 Bipolar I Disorder, Most Recent Episode Depressed, Severe
Psychotic Features
With Psychotic Features
296.63 Bipolar I Disorder, Most Recent Episode Mixed, Severe
296.53 Bipolar I Disorder, Most Recent Episode Depressed, Severe
Without Psychotic Features
Without Psychotic Features
296.6 Bipolar I Disorder, Most Recent Episode Mixed, Unspecified
296.5 Bipolar I Disorder, Most Recent Episode Depressed,
296.7 Bipolar I Disorder, Most Recent Episode Unspecified
Unspecified
296.06 Bipolar I Disorder, Single Manic Episode, In Full Remission
296.40 Bipolar I Disorder, Most Recent Episode Hypomanic
296.05 Bipolar I Disorder, Single Manic Episode, In Partial Remission
296.46Bipolar I Disorder, Most Recent Episode Manic, In Full
Remission 296.01 Bipolar I Disorder, Single Manic Episode, Mild
296.45 Bipolar I Disorder, Most Recent Episode Manic, In Partial 296.02 Bipolar I Disorder, Single Manic Episode, Moderate
Remission 296.04 Bipolar I Disorder, Single Manic Episode, Severe With
296.41 Bipolar I Disorder, Most Recent Episode Manic, Mild Psychotic Features
296.42Bipolar I Disorder, Most Recent Episode Manic,
296.03 Bipolar I Disorder, Single Manic Episode, Severe Without
Moderate
Psychotic Features
296.44 Bipolar I Disorder, Most Recent Episode Manic, Severe With
296.0 Bipolar I Disorder, Single Manic Episode, Unspecified
Psychotic Features
296.89 Bipolar II Disorder
296.43 Bipolar I Disorder, Most Recent Episode Manic, Severe

Without Psychotic Features