Question:
Q: My 6-year-old son is being treated for attention-deficit/hyperactivity
disorder, but I think the stimulant drug is making him go crazy. He threatens us, cusses and tears up his room. His pediatrician insists on keeping him on drugs to treat ADHD. I have read about bipolar disorder in children and how the symptoms look the same as ADHD, but his doctor refuses to consider that. His father has bipolar disorder.
Answer:
A: One mother of a 14-year-old son with both ADHD and bipolar disorder recalls he `bounced to the moon and back multiple times a day'' on a stimulant. Stimulant medication such as Ritalin, once it's fine-tuned to the right dose, can help some children focus if they have a brain-based attention disorder. But psychiatrists have found that the same stimulant can have the opposite effect on a child who has severe mood swings, or early-onset bipolar disorder. Several readers whose children have been misdiagnosed echo the sentiments of a mother in Rhode Island: `Find another doctor. The fact that his doctor is disregarding your valid concerns is serious. Medication should not change who your child is; it should only alleviate the symptoms.'' In the controversial arena of how to treat mental illness in young children, parents say it's important to feel confident as one of many give-and-take players on a child's health team. ``Don't be afraid to ask your pediatrician for backup from a child psychiatrist and psychologist to work with you to make sure the diagnosis is really the full picture,'' said Miriam K. Ehrensaft, Ph.D., a clinical psychologist at Columbia University. Letters from parents show how important it is to be an advocate for your child, expect a thorough psychological evaluation to start with, and to monitor side effects of any medication. Ask your doctor to check in with you soon after your child starts a new drug, but don't stop meds on your own. You'll also need to stick to healthful eating and sleeping routines. ``This mother is correct in that her child needs to be re-evaluated. My daughter had been diagnosed at 4 as ADHD,'' writes a mother in Arlington, Texas. ``She was treated for ADHD three separate times with three drugs. Each time she would become worse, self-destructive, physically violent and verbally abusive.'' Now the girl takes a low dose of a mood stabilizer. Mom's education about medication and the doctors' willingness to work with her over the years has paid off: Her daughter is an ``enjoyable, happy 14-year-old angel.'' It's common to find other disorders, such as ADHD, that overlap with bipolar disorder and make diagnosis tricky, said Demitri Papolos, M.D., co-author with his wife of The Bipolar Child (Broadway Books, 2002). (The Web site is www.bipolarchild.com.) Behavior such as hyperactivity and distractibility, for example, may look the same in a classroom but have different causes and call for different solutions. One mother from McKinney, Texas, said her almost 4-year-old son was observed for five minutes, diagnosed with ADHD, and given a prescription for a stimulant. ``Within 24 hours of taking the first dose, he became so agitated and violent he was tearing up our house and attacking his brother, my husband and me. Since our older child had been successfully treated with stimulant medication for ADHD, we knew that this was an atypical reaction,'' said the Texas mother. ``The best decision we made was not to return to that doctor.'' Her son, adopted at birth, has been diagnosed with early-onset bipolar disorder, put on a mood stabilizer and is now stable. A Fredericksburg, Va., single mother of two children being treated for bipolar disorder said: ``There are just too many mental and physical conditions and symptoms that overlap. It is a difficult job to properly diagnose. Sadly too many patients are misdiagnosed.'' Request full psychological testing, and ask for a referral to a pediatric psychiatrist once you have the evaluation results, suggests an Appleton, Wis., parent whose child started taking ADHD medication at age 2 ½. • For Internet links to more resources, go to the Web site of the Child & Adolescent Bipolar Foundation at www.bpkids.org. • The Web site for Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is www.chadd.org.
