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This child should be evaluated for the possiblity of childhood onset bipolar disorder.

This can often look like ADHD (often like ADHD and ODD) when it occurs in children and is VERY frequently misdiagnosed as such.

When this happens and medication is given (both stimulants and antidepressants/Strattera), manic episodes can be triggered and aggressive behaviour is frequently on of th emost noticeable reactions to ADHD medications in bipolar children:

From a Google search for bipolar childhood ADHD

"An estimated 50 percent to 80 percent of those with COBPD have ADHD as a co-occuring diagnosis.

Since stimulant medications often prescribed for ADHD (Dexedrine, Adderall, Ritalin, Cylert) have been known to escalate the mood and behavioral fluctuations in those with COBPD, it is important to address the bipolar disorder before the attention-deficit disorder in such cases. Some clinicians suggest that the prescription of a stimulant for a child genetically predisposed to develop bipolar disorder may induce an earlier onset or negatively influence the cycling pattern of the illness.

What is the difference between ADHD and COBPD?

Several studies have reported that more than 80 percent of children who go on to develop COBPD have five or more of the primary symptoms of ADHD-distractibility, lack of attention to details, difficulty following through on tasks or instructions, motor restlessness, difficulty waiting one's turn, and interrupting or intruding upon others. In fact, difficulties with attention are so common in children that ADHD is often diagnosed instead of bipolar disorder. Actually, ADHD often appears before a clear development of the frequent alternating mood swings and prolonged temper tantrums associated with COBPD.

While the symptoms of COBPD and ADHD may be similar, their origins differ. For instance, destructiveness and misbehavior are seen in both disorders, but these behaviors often seem intentional in those with COBPD and caused more by carelessness or inattention in those with ADHD. Physical outbursts and temper tantrums, also features of both disorders, are triggered by sensory and emotional overstimulation in those with ADHD but can be caused by limit-setting (e.g., a simple "No" from a parent) in those with COBPD.

Furthermore, while those with ADHD seem to calm down after such outbursts within 15 to 30 minutes, those with COBPD often continue to feel angry, sometimes for hours. It is important to note that children with COBPD are often remorseful following temper tantrums and express that they are unable to control their anger.

Other symptoms, such as irritability and sleep disturbances often accompanied by night terrors with morbid, life-threatening content (e.g., nuclear war or attacking animals), are commonly seen in those with COBPD but are rarely associated with ADHD. "

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