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Bipolar Disorder (Children and Adolescents)

13-year-old diagnosed with ADHD, bipolar

04/09/2009

Question:

I have a 13 year old sister who was diagnosed with ADHD at the age of 9. At 11 after no improvement with medications, she was with Bipolar disorder. She is on lithium, I`m not sure the dosage, but nothing seems to be helping. My parents have tried everything. I`m wondering if she has ODD. She is the most defiant child I`m ever seen. She is very promiscuous, speaking of sex and sexually actions constantly. She feels no remorse for any actions taken. Medications either have NO effect or send her into a "zombie" state. She often threatens to kill other siblings in the home. Her counselor doesn`t even know how to respond to this behavior.

Is there anything my family can do to help this child. We love her and want to see her thrive, but she WILL NOT let you love her. She is evil, conniving, and mischivious. We are all at our wits end!!

Answer:

Thank you for your question. The first question that comes to mind, as a psychologist hearing about a new case, is whether the patient has received a comprehensive and detailed psychological assessment leading to an accurate diagnosis(es) from a trained mental health professional?

You mentioned your sister has "ADHD" and "bipolar". Do you feel confident the mental health professional(s) involved conducted a comprehensive and detailed psychological assessment? As symptoms can mimic several other disorders and many disorders occur together (comorbidity), a comprehensive and detailed psychological assessment of ALL the possible psychiatric diagnoses needs to be conducted to identify which diagnoses and symptoms are present, which can be ruled out, which need to be treated, and in which order.

If you don't think such a comprehensive assessment was conducted, I'd suggest starting there. Call your local university, community mental health center, or National Association of Mentally Ill chapter to ask for names, locations, and phone numbers of mental health professionals who have expertise assessing and treating childhood psychiatric problems, especially bipolar disorder.

If you feel your sister has received an accurate assessment and diagnosis(es), my next question would be: Is she getting effective treatment (medications, therapy, and special education services, if needed) for this diagnosis(es)? If no, once again, I'd suggest calling your local university, community mental health center or National Association of Mentally Ill chapter to ask for names, locations, and phone numbers of mental health professionals who have expertise assessing and treating such diagnoses in children.

If your sister does have ADHD and bipolar disorder, the first line of treatment is usually medication to stabilize the bipolar mood problems. Possible medications include Lithium, Depakote, Risperdal, Seroquel, Abilify, and/or Zyprexa. After the mood symptoms have been stabilized, psychiatrists can then "carefully" (i.e., starting at low doses and slowly increasing) prescribe medications for the ADHD symptoms including Ritalin, Concerta, Metadate, Adderal, Dexedrine, Focalin, Daytrana, Vyvanse, and/or Strattera. I say "carefully" because these "ADHD medications" can sometimes induce manic symptoms. That's also one of the reasons they can't be prescribed before stabilizing the bipolar symptoms.

In addition to having a child psychiatrist on your team, a therapist with expertise in treating children with bipolar disorder is needed and, if there are school issues, a special education team may also be important.

Finally, you mentioned that your sister "often threatens to kill other siblings in the home. Her counselor doesn't even know how to respond to this behavior." This does require an immediate response from your counselor in terms of assessing the degree of seriousness of these threats and the risk sibling are in and the development of a risk-management plan with your sister, siblings, and family to increase the safety of everyone concerned.

I hope this answer is helpful. My best wishes to you, your sister, and family.

For more information:

Go to the Bipolar Disorder (Children and Adolescents) health topic, where you can:

Response by:

Nicholas   Lofthouse, PhD Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University