ADHD vs. Bipolar or Neuro

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ADHD(vs. Bipolar or Neuro)

• Larry Fisher, Ph.D.
• UHS Neurobehavioral Systems

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For More Information

• Larry Fisher, Ph.D.
• UHS Neurobehavioral Systems
• 12710 Research Blvd, Suite 320
• Austin, TX 78759
• 512-257-3468 fax [phone]
• Email
• c n s g r o u p _at_ s w b e l l .n e t
• www.ragebehavior.com

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ADHD, Pediatric Bipolar, Neuro Kids

• ALL START IN CHILDHOOD
• Attention Deficit Hyperactivity Disorder
• ADHD starts before age seven
• Pediatric Bipolar Disorder
• Starts before puberty
• Neurobehavioral Disorders
• Neuro often prenatal or perinatal in origin
• Initial symptoms start in early childhood

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ADHD

• First identified in1917
• pandemic of von Economos encephalitis
• Called Hyperkinesis
• Later renamed
• Minimal Brain Dysfunction
• Renamed again
• Attention Deficit Disorder (ADD)
• Now ADHD (Inattentive type, hyperactive
  impulsive type, combined)

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ADHD

• Affects 3-9 percent of school age kids
• Symptoms persist into adulthood (40)
• ADHD kids spend less time immobile
• 66 less than normal kids
• (Teicher, et al., 1996)
• Hyperactivity is only apparent
• When ADHD kids are asked to sit still
• Or during sleep (Porrino, et al., 1983)

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ADHD

• Symptoms must emerge before age 7
• Severe enough to cause impairments
• Not due to other known mental disorder
• Not due to PDD or Psychotic disorder
• For at least six months
• At least six symptoms of inattention
• Or six symptoms of hyperactive-impulsive
• Or both (for combined type)

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ADHD

• ADHD kids are NOT more active in play
• ONLY when asked to stop and sit still
• Therefore, we see a diminished
• (1) ability to INHIBIT activity
• Therefore impulsive, hyperactive (immature)
• (2) ability to INHIBIT response to distractions
• Therefore inattentive (not age appropriate)
• The brains brake is not working well

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Pediatric Bipolar Disorder

• Bipolar (Manic Depressive) Disorder
• Pediatric Mania (Geller et al., 2002)
• Hyperactive even in play
• ADHD normal during play
• Racing thoughts, rapid speech
• ADHD shows normal rate of cognition and speech
• Little need to sleep
• ADHD kids may be too hyper to fall asleep
• But their need for sleep is otherwise normal
• Euphoria, grandiosity - unique to Mania

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ADHD versus Mania

• ADHD poor brakes
• cant stop - in age appropriate manner
• Mania too much acceleration
• Brain is racing too fast
• Both may show
• Hyperactivity, distractibility, irritability
• Mania shows severe mood swings
• Elation, grandiosity, racing thoughts/speech

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Irritable Neuro Kids

• Irritability may be based on disorders of brain
  chemistry
• ADHD, Bipolar Disorder, Schizophrenia, etc.
• Or it may be a Neuro kid with early brain
  damage from
• Drugs or alcohol used in pregnancy
• Difficult or premature delivery
• Very early traumatic brain injury
• Genetic diseases
• Brain electrical d/os

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Impulsive/Irritable

• Irritability short fuse.
• Early onset/persistent tantrums
• Impulsive behavior
• Impulsive aggression
• These behaviors are NOT premeditated.
• Irritable behaviors are not planned
• Quick temper, hot temper, too much emotion
• Differs from Conduct D/O, Psychopathy
• in cold blood, premeditated, too little emotion

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Interventions

• GET TOUGH approach does NOT work
• Boot Camp is not effective, early relapse
• Group therapy does not work either
• Early interventions for at-risk kids work
• For irritable/hyper kid, medication may work
• Family support also effective
• MST (Multi Systemic Therapy)
• support parent provide wrap-around
• Identify psychiatric ADHD or BIPOLAR
• Identify brain disorders
• Treat comorbid PTSD, Substance Abuse, etc.

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ADHD Life Impairments

• Childhood
• Academic and social issues
• Adolescence
• Substance abuse, driving accidents
• Teen pregnancies, dont finish school
• Young Adults
• Poor job stability, disrupted marriages
• Financial difficulties, impulsive crimes

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Other Psychiatric Disorders?

• Disorders often comorbid with ADHD
• Substance or Alcohol Abuse
• Oppositional Defiant Disorder
• Conduct Disorder
• Mood Disorders (Bipolar or Depression)
• Anxiety Disorders
• Obsessive Compulsive Disorder
• Learning Disorders

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Stimulants and others

• Methylphenidate-Ritalin
• Dextroamphetamine-Dexidrine
• Adderall
• Pemoline (Cylert)
• Amoxitine-Strattera (non-stim)
• Other Wellbutrin, Clonidine

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Treatment Types

• Medications
• Stimulants, Non-stimulants
• Antidepressants, Alpha-2-Agonists
• Parent Training Positive Discipline
• BIP (Behavior Intervention Plan)
• Structure routines, schedules
• School supports (IEP)

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Assessments

• Comprehensive evaluation is best
• Check for IQ, learning disabilities
• Check for other diagnoses
• Rule out Bipolar, Neuro, other
• ADHD rating scales
• Conners Scales for Teachers
• Neuropsychological testing
• Continuous Performance Test (CPT

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Summary

• ADHD
• A common childhood disorder
• With many causes
• Often genetic (DAT-1, DRD2, D4 genes)
• Can produce serious life distress
• Learning, behavior, social, teen safety
• Goal is resilience
• Positive discipline, structure, meds