Differentiating ADHD from Bipolar Disorder has been an important area of concern, given the negative impact of medications for ADHD in those with an untreated mood disorder. Some hypothesize that stimulant medication exposure can permanently alter the course of Bipolar Disorder in certain children. In addition, atomoxetine, FDA-approved for the treatment of ADHD, has been clinically found to be a potent mood destabilizer. In 2004, Drs. Henderson and Hartman found that roughly 33% of children and adolescents became mood disregulated on atomoxetine. In 2008, Europe warning labels for atomoxetine added mania, aggression, and hallucinations as dangerous side effects. No changes have been made to the American warning labels. It is concerning that the checklist of symptoms for ADHD is almost the same as that of Bipolar Disorder in children and adolescents. What if your child’s clinician guesses wrong?
Bipolar Disorder most commonly starts in adolescence, but it can begin in children. We always think of highs and lows in “Bi”-polar disorder, but the reality is most young patients report a wide range of emotions. Deep depression, wild elation, silly giddiness, the blues, irritability, and even reckless pleasure seeking. In other words, they don’t show all the symptoms of mania at the same time or they bounce between an irritable mania and depression in the same day. It is a confusing picture.
Neuroimaging can help to sort out the diagnostic puzzle. There is overwhelming neurobiological evidence for the existence of ADHD. A multitude of functional imaging studies utilizing a diversity of modalities, including SPECT, functional MRI (fMRI), PET, and QEEG, have repeatedly demonstrated similar results in children and in adults. Drs. Cherkasova and Hechtman reviewed this extensive number of research studies which consistently showed reduced activity during a concentration task in the prefrontal cortex, orbital frontal cortex, and caudate nuclei in patients with ADHD. In addition, abnormal function and anatomy has been reported in the cerebellum of patients with ADHD. Some have described these consistent findings as an “endophenotype” (a measurable attribute of a disease which cannot be seen with the unaided eye). ADHD is not a simple diagnosis. Many other conditions, such as traumatic brain injury, fetal alcohol syndrome, bipolar disorder, and toxic encephalopathy, also produce clinical symptoms (impaired attention, hyperactivity, and impulsivity) similar to ADHD and pose a problem in the differential clinical diagnosis of ADHD. To further hinder the diagnostic process, several specific symptoms of ADHD also are part of the diagnostic criteria for other disabilities such as learning disabilities, petit mal seizures, anxiety, personality disorders, bipolar disorder, and/or depression. Neuroimaging can have a key role in differentiating these neurophysiological processes.
With neuroimaging, Bipolar Disorder presents very differently. In the same manner, traumatic brain injury, or toxic brain injury look very different on neuroimaging, but may have the same symptoms as ADHD.
If you or someone you know is suffering from bipolar disorder please get in touch with us today. Visit our contact us page to find out how.