ADD or Bipolar? Why it’s hard to diagnose the difference.

image via Flickr, Matt Anderson

image via Flickr, Matt Anderson

Differentiating between Attention Deficit Disorder and Bipolar Disorder can be very challenging, particularly for the inexperienced clinician. In part, this is because these two syndromes share some common behaviors, but also because there is an overlap in the incidence of the two problems.

Research and clinical experience suggest that a many as 30% of individuals with Bipolar Disorder also have ADD and somewhere around 3.5% of people with ADD have Bipolar Disorder. Therefore, there are a number of individuals who have both ADD and Bipolar Disorder.

While there can be shared characteristics between the two syndromes, there are a few factors that can help differentiate them. ADD is a chronic problem that shows up early in childhood and manifests itself continuously throughout life. On the other hand, Bipolar Disorder is very difficult to recognize before the early teen years and when it does show up, is episodic in nature.

In my experience, more than 95% of people with ADD demonstrate markers of what I call “neuromaturational delay” such as gross or fine motor incoordination, excessive numbers of soft neurological signs, persistent articulation difficulties in childhood, or a history of bedwetting or febrile seizures. This is not the case with individuals with Bipolar Disorder.

Finally, since both problems tend to run in families, a positive family history can help point us toward the right diagnosis.


Concerned about getting the right diagnosis?  Dr. Liden‘s (free!) download ebook, ADD/ADHD Basics 101, will steer you in the direction of a clinician you can trust and give you the knowledge you need to KNOW you have the right diagnosis.  Download ADD/ADHD Basics 101 right away!

 

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Why ADD/ADHD is Frequently Misdiagnosed

image via Flickr, Raul Hernandez Gonzalez

image via Flickr, Raul Hernandez Gonzalez

The ways that ADD shows itself are highly variable from person to person depending upon an individual’s age, unique personality characteristics, profile of strengths and weaknesses, and the stresses and demands place upon him.  Differences in any one of these areas combine with the characteristics of ADD to produce an unlimited variety of problem behaviors.

For example, the preschooler with ADD who is strong-willed, sensitive, and intense may be labeled as a behavior management problem; the school-age child with ADD, who has difficulty organizing his thoughts into words and following directions and has problems with phonetics may be diagnosed as language disordered; the adolescent with ADD who is defiant and unkempt and whose grades are suddenly slipping with the new academic demands may be suspected of abusing drugs and alcohol; and the adult with ADD who is shy, socially withdrawn, overweight, and has a low self-esteem may be seen as being depressed.

Because of our limitations as observers of human behavior, we tend to judge the book by its cover. Our snap judgments often interfere with responsibly looking below the surface to investigate the possible role of ADD in these problems.

Our suspicions regarding the cause of a problem naturally influence to whom we go for help. Commonly, this means we seek help from a single professional who has expertise in the area in which we think the problem lies. This increases the possibility of misdiagnoses in several ways.

Even good clinicians’ approaches to problems are colored by their disciplinary bias and training; that is, they generally find what they are looking for. The psychiatrist makes a psychiatric diagnosis; the neurologist makes a neurological diagnosis; and the school psychologist makes an educational diagnosis. Furthermore, depending upon their training and experience, many clinicians may not even consider the possibility of ADD.

All of this serves to reinforce the need for a comprehensive, systematic, team approach to evaluating all behavior, learning, social, life performance, and chronic health problems.

The fact that there is no definitive test for ADD further complicates diagnosis. While there is some general agreement, there are not universally accepted diagnostic criteria for ADD. This means that making the diagnosis of ADD requires qualitative data interpretation and decision-making. Unless it is highly systematic, such qualitative diagnostic techniques are susceptible to multiple sources of error. Pediatricians, family practitioners, and other health-related professionals who have received training in transdisciplinary approaches to diagnosis and treatment are uniquely qualified to conduct effective team evaluations.


How do you know if your chosen health care provider is qualified to diagnose ADD/ADHD accurately?  Dr. Liden gives you a series of criteria and key questions to ask when seeking an accurate diagnosis for ADD in ADD Basics 101.