Kids and Mental Disorders – ADHD

Children and mental disorders – when is too soon for diagnosis?

I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders.  My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum DisorderBorderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most Attention Deficit Hyperactivity Disorderof these disorders within my social circle, and I know them on a professional level.

Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder)  A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work.  Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting.  (pretty typical behavior for a truly ADHD kid)  A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet.  The mom was asking for advice.

Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.

Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed.  I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy.  His siblings aren’t allowed to bug him during this time either.  He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.

One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up.  I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.

Mental Disorders - ADHDWhat troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage.  She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning.  This gives me pause for concern.

I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child.  Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment.  But the medications weren’t working, and I am not so sure about the bipolar disorder.

Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern.  Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.

The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13

The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHDNIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.

The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults.  To complicate matters, symptoms of various Cerebrum Lobesdisorders in children are similar to one another.

Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders.  Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.

Because of our family history (not just mine), I watch my children very carefully.  I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another.  Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD.  I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.

Our understanding of mental disorders is still evolving

I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult.  How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself.  Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working.  To me, this means that the treatment was with the wrong meds and for the wrong disorder(s).  In addition, her management skills weren’t the best.

As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder.  I will want them to be treated for the right disease.  My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.

I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion.  Preferably the opinion of a pediatric Ritalin - ADHD Medicinepsychiatrist – or even a pediatric behavioral neurologist.  These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.

Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”.  That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions.  Just seems like common sense.

Melissa Lind


8 thoughts on “Kids and Mental Disorders – ADHD

  1. […] with medication, adopting a stable lifestyle, and developing healthy coping strategies, may all keep the condition under […]

  2. […] disorders are harder to see in a movie as a single issue as they often occur with other disorders – as they do in real […]

  3. […] with medication, adopting a stable lifestyle, and developing healthy coping strategies, may all keep the condition under […]

  4. […] it at first.  I thought of every other thing it might be and tried really hard to convince the therapist “that isn’t me… not […]

  5. Mar Peters: You didn`t leave any link. Why not?

  6. Melissa: What is “to much” for this blog?
    Do you mean going into details about a subject like this one?
    Just keep up your good work – write about things you are passionate about! 🙂

    -Kurt

  7. AS a bipolar patient of 25 years, I look back trying to figure out if I was bipolar as a child. After a severe event with my 88 yr old mother, I discovered that she is a malignant narcissist, and my father was bipolar. All those feelings in childhood, were they due to my bipolar DNA or did my bipolar develop after the home chaos and my genetic predisposition. Hard to tell. Even know, sometimes I doubt that my anxiety disorders are related to bipolar or to a 60 yr old codependency. Bipolar is a mess that sometimes rapic cycles and sometimes mimics straight depression. How can we determine, with exactitude, if a child had bipolar or another condition. My humble opinion is that should treat a child by the symptoms, without labeling him/her with any diagnosis until they reach adolescence, at least.

  8. WriterMelle says:

    Hi – I agree, my concern is that they did label this child with two different diagnosis – one of which technically does not exist. The DMS suggests that child be labeled with a temporary diagnosis of Pervasive or Pediatric Mood Disorder which could be converted to BP when the child is old enough. Even though there is a stigma and it is a technically inappropriate diagnosis, some physicians are labeling children as bipolar and treating with bipolar meds. If the meds were working – I wouldn’t be as concerned but clearly they were not – indicating that most likely the diagnosis was wrong. It seems – in a lot of child cases – that the parents have no skills for management. Unfortunately, you cannot make the issues go away – you must manage them – even in adulthood. Sometimes management can be mainly done with medication but there are a lot of other tricks that we must learn.

    I have one or more children that will be likely Bipolar – I watch them everyday. When I was an adolescent, it was clear in my mind that there was “something wrong” with me. My parents – even though they were health professionals – dismissed my concerns (mental disorders were not popularly treated at the time and medications were horrible and limited) even though I asked repeatedly to be taken to a psychiatrist. The moment one of my kids suggests there is “something wrong” they will be in the office immediately – until then, or until it is problematic enough to interfere with school – I wait and watch, “managing” behavior at home.

    I agree that clearly defined symptoms should be treated but based on my experience, children are difficult to diagnose and one should take extreme care in doing so too early – not to simply take whatever the NP, PA, GP or even the “regular” psychiatrist says. Medication affecting the brain can have drastic consequences – AND from some of my work, drug companies and physicians have been severely sanctioned for promoting and using medications as “restraints” when there was no established protocol. Common example, Risperdal used in “difficult” children – when it was not approved for any pedi treatment and was clearly given as a pharmaceutical restraint – resulting in breast development in kids as young as 4. I would fear that with the mom’s complaints and the doctors label – the child would be considered a candidate for an antipsychotic like risperdal, abilify or such — none of which should likely be used in kids but are.
    I really appreciate your input – and hope I am not too wordy.

    All that is “too much” for this blog (meaning; I can’t get all that technical and gripey in the blog itself – it would be too long and readers would probably lose interest…)

    melle (Melissa Lind)

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