Children with ADHD at Risk for Bullying and Self Harm

ADHD experts have long known that children, teens and adults with ADHD are at increased risk for bullying at school, work and even at home.

Unfortunately, a recent study showed children bullied by peers “when they are younger are up to three times more likely to harm themselves in adolescence.”

Researchers followed 1,116 sets of twins from 1994 to 1995 until their twelfth birthday and discovered almost 8% of those who were victims of frequent bullying deliberated tried to harm themselves. In contrast, only 2% of those who were not bullied tried self-harming behaviors.

Observed self-harming behaviors included:

• Attempted suicide by strangulation
• Cutting arms
• Biting body parts
• Banging their head against walls
• And pulling out clumps of hair.

In our practice, we have seen kids who deliberated excessively tattooed parts of their body as a result of the stress of being bullying. One teenage girl told me she had done so in hopes her tormentors would leave her alone because they would think she was crazy.

Another bully-abused teen in our practice explained he tattooed his arms to keep from “slicing and dicing them with my knife.”  His tattoos were done using regular ink from writing pens he broke open. As a result of the rubbing alcohol he used to extract the ink, both of his arms were terribly scarred and disfigured under the tattoos.

Another 11 year-old showed up with dozens of bruises on his arms and legs-all in the shape of bite marks. He literally had “drawn blood” to overcome the anger and stress of being bullied by a 13 year-old who lived a few doors down.

We suspect all of the above listed self-injury, self-harm behaviors are used by the child to try to cope with the extreme stress and distress of being bullied. Even ADHD children eventually learn how to avoid pain and suffering, but unfortunately are often slow to pick up on the little social clues that warn them  of danger and are therefore subjected to more abuse and harm.

Bullies tend to get a lot of satisfaction out of seeing distress and fear in their victims. They often evoke such responses by directly or indirectly abusing the victim by frequently displaying these bullying behaviors:

• Kicking, hitting, and shoving
• Playing mean tricks
• Verbally abusing them in front of peers
• Telling and spreading lies about them
• Excluding them from peer relationships
• Totally ignoring their existence
• Threatening them over the internet.

Of the children in the self-harm-bullying group of the above mentioned study, there was an increase in psychotic behavior, conduct disorder, depression, and borderline personality disorder.  It’s no small wonder as all of these psychological problems can occur as a result of stress. I expect the group also suffered loads of generalized anxiety disorder-it just wasn’t mentioned.

It’s important to note that many children who are victims of bullying resort to self-injury after they have sought help from a peer or an adult and not been successful. When all else has failed, they turn to more drastic-attention-getting behaviors in a plea for help. Sadly, they are often blamed for their own behavior.

That brings us back to the opening statement in this article: children, teens and adults with ADHD are at increased risk for bullying at school, work and even at home and are more likely to harm themselves in adolescence when bullied prior to age twelve years.

With that fact firmly in mind, our task should be to detect bullying at as early a stage as possible and prevent these kids from harming themselves.

This is best done by understanding why and how bullying occurs and recognizing the early signs and symptoms of bullying in your ADHD child, teen or spouse.

Special note: Many teens and adults with ADHD who suffer bullying probably engage in some type of self-harm or high risk behavior because of the stress of the bullying. It’s just we don’t know how often it occurs and don’t have current studies to relate numbers of victims.

We’d love to have your comments on this topic. Maybe you can share a bullying experience from your childhood or that involves a loved one that has negatively affected you or them in some way.

In our next article, we’ll explore the early signs and symptoms of bullying.

Frank Barnhill, MD

References:

BMJ 2012;344:e2683 doi: 10.1136/bmj.e2683 (Published 26 April 2012)
Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study
http://www.bmj.com/highwire/filestream/581440/field_highwire_article_pdf/0.pdf
Accessed 052012.

Pediatrics Staff. Modern Medicine. Victims of bullying more likely to self-harm. May 10, 2012 on-line issue. Assessed 051012.

Here are a few previous article you might want to peruse:

ADHD Impulsive Behavior and Risk of the Choking Game

http://www.mistakenforadhd.com/2012/04/adhd-impulsive-behavior-and-risk-of-the-choking-game/

Adolescents More Prone to Cyberbullying

http://www.mistakenforadhd.com/2010/12/adolescents-more-prone-to-cyberbullying/

Kids and Teens Who Suffer Bullying More Likely to be Misdiagnosed as ADHD

http://www.mistakenforadhd.com/2010/10/kids-and-teens-who-suffer-bullying-more-likely-to-be-misdiagnosed-as-adhd/

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ADHD children treated with atypical antipsychotics and antidepressants for depression or other behavior disorders are at greater risk for developing diabetes mellitus.

While atypical antipsychotics are traditionally used to treat schizophrenia, I’ve found more and more doctors using them to treat bipolar disorder, agitated depression, anxiety associated with depression, major depressive disorder, oppositional behavior disorder, conduct disorder, and obsessive-compulsive behavior disorder.

It’s currently estimated in excess of 40 children per 1000 children in the U.S. are being treated for one of the above behavior problem diagnoses using second generation (atypical) antipsychotics. This number has increased dramatically since 1996 at which point only about 9 out of 1000 kids ages 5 to 18 years were exposed to these drugs.

Unfortunately, with increasing use of atypical antipsychotics and antidepressants, significant side effects of these medications are starting to pop up-the most concerning being diabetes mellitus or sugar diabetes.

A new study released in the December issue of the medical journal Pediatrics showed a four-fold increased risk of diabetes among children exposed to atypical antipsychotics and a little less in those treated with antidepressants. While the study doesn’t well-define the exact number of children, who develop diabetes as a result of exposure to these drugs, it does highlight our need to watch these children closely for weight gain and signs of diabetes.

The most common antipsychotics and antidepressants I see used in treating behavior problems in both ADHD children and those who are not ADHD include:

• Aripiprazole or Abilify
• Clozapine or Clozaril
• Olanzapine or Zyprexa
• Quetiapine or Seroquel
• Risperidone or Risperdal
• Ziprasidone or Geodon
• Paroxetine or Paxil
• Fluoxetine or Prozac
• Citalopram or Celexa
• Sertraline or Zoloft
• Duloxetine or Cymbalta

To protect your child from diabetes mellitus when they are taking an antidepressant or atypical antipsychotic:

• Thoroughly discuss the use of these medications and the risk for side-effects with your child’s doctor before starting any medication
• Be sure his or her blood sugar, blood chemistries, and hemoglobin A1C are tested before starting therapy (some of these drugs also cause problems with sodium and chloride-bicarbonate levels)
• Discuss the need for any lifestyle changes your child will need make because of the medication-diet-exercise-weight control
• Watch for excessive weight gain (more than 10% of pretreatment weight)
• Keep an eye out for the subtle signs of diabetes; bed-wetting, increased thirst or urination, food cravings-especially sweets, fatigue, excessive sleepiness, skin sores that heal slowly or won’t heal-weight loss usually only occurs if diabetes is advanced
• Have his or her blood glucose and hemoglobin A1C tested monthly for the first six months, as it’s often during the first six months that children, teens and adults are most likely to develop high blood sugars
• Repeat blood glucose testing and hemoglobin A1C at least once every six months as long as they are taking the drug.

While it’s true that both antidepressants and antipsychotics have definite places in the treatment of depression, psychosis, and aggravated behavior disorders, we as parents and physicians must be diligent in watching for and preventing serious side effects of these mind-altering drugs.

In addition…ironically, diabetes suffered while taking antidepressants or antipsychotics might cause ADHD behavior resulting in the misdiagnosis of ADHD. The symptoms of diabetes mellitus can be mistaken for the symptoms of attention deficit hyperactivity disorder!

Dr. Frank

References:

Andrade SE, Lo JC, Roblin, Fouayzi H, Conner DF, Penfold RB, Chandra M, Reed G, and Gurwitz, JH. Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics. 2011 Dec;128(6):1135-41. Accessed March2012.

Geller, Barbara MD. Diabetes Risk Increased with Atypical antipsychotics in Children.  Journal Watch Psychiatry. Pediatrics and Adolescent Medicine. March 2012:Vol 2;3: 22.

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Diagnosis of ADHD-Drugs that cause ADHD Misdiagnosis

Many drugs, both over-the-counter and prescription can cause signs and symptoms of ADHD that might confuse accurate diagnosis and lead to misdiagnosis of ADHD and other behavior disorders.

One such drug has recently been the topic of a US Food and Drug Administration (FDA) safety alert-Valproate-a medication used for treatment of seizures and bipolar disorder-depression.  The FDA issued a safety announcement about valproate based on a 10-year study that confirmed that “fetal exposure to valproate impairs IQ well into childhood.”

It appears women who took valproate during pregnancy delivered children who later had significantly lower intelligence quotients (IQs) than children who had never been exposed to the drug. In addition, the effects on the unborn child’s future IQ were directly related to the dose of valproate taken by the pregnant mom-the lower the dose, the less the decrease in IQ.

This data supports the beliefs of many ADHD experts-that a child’s neurodevelopmental well-being is often determined by what the mother is exposed to both before and during her pregnancy. Valproate isn’t the only drug that might cause future learning problems in unborn children. And…if a drug causes any type of learning disorder, that child will probably be diagnosed with ADHD before he or she is 7 years old.

Why would a child suffering a cognitive delay and low IQ be misdiagnosed as ADHD?

Just like ADHD, any disorder of the development, growth, maturation and function of the human brain can cause:

• Impulsivity and poor control of behavior-misbehavior
• Hyperactivity and restlessness
• Concentration problems-difficulty focusing and staying on task…
  All signs and symptoms of attention deficit hyperactivity disorder.

That means these children will probably never be properly evaluated and correctly diagnosed for neurodevelopmental disorders that are not ADHD. They may need ADHD drugs to help them focus and control impulsivity, but the best and most recommended therapy for children with neurodevelopmental disorders is cognitive behavior therapy-recognition and skills training with coaching. This type of therapy is most effectively done using a team approach with psychologists, counselors, social workers, speech therapists and learning skills tutors.

Whether you have another child with ADHD, a brother or sister with ADHD or a spouse or parent with ADHD …or not; you might just prevent your unborn child from developing ADH- like problems by using a few simple tips from ADHD experts.

For a year before getting pregnant, women should:

• eat a healthy balanced diet
• take daily multiple vitamins containing iron (if ok with their doctor)
• limit use of alcohol and tobacco
• completely avoid  illegal drugs
• take as few drugs as possible
• exercise at least 4 days a week for 45 minute each day
• get plenty of sunshine and rest.

Once pregnant, expectant moms should:

• Completely avoid alcohol and tobacco. Studies have shown both a single drink of alcohol and even second hand tobacco smoke can affect an unborn child’s brain development and cause behavior problems in preschool kids
• Eat a diet low in salt and caffeine and high in essential nutrients and balanced in protein, carbohydrates-avoiding simple sugars, and good fats
• If possible, avoid taking any type of drug, prescription or over the counter-inhaling second-hand marijuana smoke affects your unborn child as much as if you smoked it yourself
• Exercise 5 or 6 days a week unless your doctor instructs you to not to do so
• Drink plenty of water and if your doctor advises-plenty of milk
• Try to sleep at least 7 hours each night.

Of course, pregnant women should always discuss these concerns with their doctor and follow his or her advice, as that doctor will have a clearer and more accurate picture of what is going on during their pregnancy.

Those women who are currently taking valproate for seizures or bipolar depression should speak to their doctor about changing to a drug less likely to affect their unborn child before getting pregnant or as soon as they discover they are pregnant.

As always…never stop your medications or add another medication without consulting your physician. If you were to do so, serious consequences might occur! The rule is simple: “Ask first!”

Working together, maybe we can prevent the misdiagnosis of ADHD and mislabeling of behavior problem children who are really suffering from the effects of a drug during pregnancy instead of attention deficit hyperactivity disorder.

Dr. Frank

Reference:

Valproate Linked to Cognitive Delay, Autism in Children.
Www.medscape.com/viewarticle/755389. Accessed-122911.

Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations.
New England Journal of Medicine. 2010;362:2185-2193.

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Teens with bipolar disorder can act just like ADHD

In this post, I’d like to share a review I did last week on a book written by a talented young lady, Karen Winters Schwartz. Karen does an excellent job of describing teenage bipolar disorder and allows us glimpses at how it can act just like and be mistaken for ADHD and cause ADHD misdiagnosis! You can find the book on Amazon.com and Barnes&Noble.com (BN.com).

Review: Where are the Cocoa puffs?

Wow!  Karen Winters Schwartz has done something I have yet to see in almost thirty years of practice. In “Where are the cocoa puffs”, she allows the reader to vividly and clearly experience what therapists refer to as “the emotional rollercoaster from hell”-teenage bipolar disorder. She adeptly describes and renders the terrible truths of the disease; that bipolar disorder doesn’t just affect and disable the bipolar teen, but often brings his or her family intense pain and suffering and sometimes pushes them into what they call “a living nightmare”.

Her descriptions of guilt, hopelessness, anger, hate, frustration, and despair are right on target as many parents and siblings of bipolar teens and adults truly experience all of these emotions when dealing with the bipolar one.

She perfectly describes the fascination that others feel when the bipolar teen is in his or her manic stages, as during this time, they are perceived as energetic, highly creative, and can be endearing and adorable. This explains why many of us will put up with them and their contagious behavior until they finally spiral into full manic episodes and fall into the depths of depression.

Karen’s book is a “must read” for all parents, siblings and spouses that suspect their loved one suffering from an emotional-behavioral-psychological disorder and want answers to all of the whys. As she points out, children who actually suffer from bipolar disorder have been misdiagnosed as ADHD and are being wrongfully labeled and treated. Just like an ADHD child, when untreated or inadequately treated, a bipolar child will fail to reach his or her greatest potential in life.

Frank Barnhill, MD

Author:The ADHD book “Mistaken for ADHD”

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As we discussed earlier, teens are particularly prone to depression because of peer-parent-teacher pressure to mature faster, earlier or for “whatever reason”; the stressors of middle school to high school transitions; and their need to “find themselves”. These are really just a few reasons that a teen might become depressed and most experts agree that whatever the cause of depression, earlier detection and treatment translates into better results and outcomes.

With these thoughts in mind, our goal in depressing teen depression should be to use the best screening tool to prevent your behavior-disordered teen from suffering ADHD misdiagnosis and inappropriate treatment.

One of the easiest to use screening questionnaires, the “Patient Health Questionnaire 9” (PHQ9) may be used to effectively screen teens for signs and symptoms of depression. It is very useful in detecting major depression in adolescents and should be used in evaluating all behavior problem pre-teens and teens. The PHQ9 can be completed in just a few minutes, used on multiple occasions to assess the presence or severity of depression, and allows for scoring severity based on how often symptoms occur.

Here are examples of the questions asked on the PHQ9 based on how frequently the symptoms occur from “not at all” to “nearly every day”:

1. I feel down or depressed or in a hopeless situation

2. I have lost interest or pleasure in doing things

3. I feel tired or have no energy

4. I’m having problems with sleep- too much or too little

5. My appetite is poor or I eat too much

6. I feel like I’m a failure

7. I can’t concentrate

8. I’m restless, hyper or fidgety or I feel like I’m moving in slow motion

9. I would be better off dead; I’m worthless and deserve whatever happens to me.

I bet you can see how teen depression could be confused for ADHD, as they both share the symptoms of poor self-esteem, problems with concentration, impulsivity, hyperactivity and social difficulties.

What happens when a depressed teen is treated for ADHD?
Often, ADHD drugs will help symptoms of depression for a few weeks or months. ADHD drugs will literally cover-up or mask the real diagnosis-depression and as depression goes undiagnosed and untreated, the teen will be at greater risk of failure in life- suicide-academic failure-severe social interaction problems-work related problems. Effective treatment of teen depression not only includes counseling and behavior intervention-training, but in over 85% of all cases will also include antidepressant drugs. These are just a few of the reasons I included an entire chapter on depression diagnosis and treatment in “Mistaken for ADHD”.

Please share your comments and suggestions about this important childhood, teen and adult psychological-behavior disorder.

Dr. Frank

You might want to take a look at these earlier posts:

Teen Depression may be Misdiagnosed as ADHD
http://www.mistakenforadhd.com/284/teen-depression-may-be-misdiagnosed-as-adhd/

Signs of Teenage Depression
http://www.mistakenforadhd.com/114/signs-of-teenage-depression/

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Teens have many reasons to become depressed:

• The transition from middle school to high school requires dramatic emotional, social and academic changes
• They receive pressure from teachers and parents who expect them to become more mature because they are now nearing adulthood
• Teens often struggle to “figure-out” who they are (their identity), why they are (a purpose in life), and how they fit into society (self-esteem and self-value).

As a result of all of these pressures, teens are particularly prone to depression and anxiety. Often, they will try to hide the most obvious symptoms of sadness, crying, fatigue, problems sleeping and appetite changes. But… aren’t able to suppress irritability, mood swings, inattentiveness and impulsivity-all symptoms of ADHD.  These signs and symptoms might cause ADHD misdiagnosis and lead to inappropriate ADHD treatment and drugs, when in fact the teen really needs therapy for depression.

How do we diagnose depression in teens?

A screening questionnaire, the “Patient Health Questionnaire 9” may be used to screen teens for signs and symptoms of depression. It has been shown to be highly effective in detecting major depression in adolescents and should be used in evaluating all behavior problem pre-teens and teens.

In my next post, we’ll discuss how this valuable screening tool might keep your behavior-disordered teen from suffering ADHD misdiagnosis and inappropriate treatment.

Dr. Frank

You might wish to take a look at these ADHDbehavior.com articles:
How Teenage Depression May be Confused with ADHD
http://adhdbehavior.com/index/modules/wfsection/article.php?articleid=84

Is My Fifteen Year Old Depressed?
http://adhdbehavior.com/index/modules/wfsection/article.php?articleid=38

And… these previous mistakenforadhd.com posts:

http://www.mistakenforadhd.com/122/diagnosing-and-treating-teen-depression/

http://www.mistakenforadhd.com/138/behavioral-therapy-and-the-medications-used-to-treat-teenage-depression/

http://www.mistakenforadhd.com/152/how-to-tell-when-behavior-therapy-and-medications-for-teen-depression-are-working/

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       In our last post, we discussed some of the signs of teenage depression that are often confused with ADHD, such as poor concentration and social –self-esteem problems.

Before we cover today’s topic: Diagnosing and Treating Teen Depression, I’d like to tell you about Gracie. I’m sure you know a kid just like Gracie. There seems to be a 10 year-old Gracie in every school….

Gracie’s mom explained why her teacher thought she was ADHD – Gracie couldn’t focus. She just didn’t pay attention in class and had terrible grades…because she often forgot to do her homework or forgot to bring it in.

Her teacher and mom agreed; Gracie wasn’t impulsive, but got frustrated so often that she would cry and become disruptive “at the drop of a hat”! She had few friends and those who “stuck by her” seemed to avoid her most of the time.

Gracie was treated for ADHD for about six months before I did her evaluation. She just wasn’t getting better on 3 different ADHD drugs. Gracie had been misdiagnosed as ADHD when she was really suffering from depression.

So… how did we make the correct diagnosis?

I discovered what was bothering Gracie, by asking many questions. Here are just a few of the more than 30 clues:

Gracie:

• Was sad more than happy
• Cried often for no reason
• Complained of being tired (check for thyroid disease!)
• Slept too much

Yes, Gracie was depressed. We never discovered the cause of her depression….that’s not uncommon in kids and teens. It just seems they fall prey to depression for little or no reason.

So, what did we do to help Gracie?

• First, every depressed person needs to make lifestyle changes such as avoiding drugs, alcohol and risky behaviors… so I asked Gracie’s mom to stop smoking around her and remove all alcohol and guns from the home. Additionally, her mom was to remove all prescription drugs from easy access.
• Secondly, 98 percent of depressed teens will need medications to replace one deficiency or another, whether thyroid hormone (if thyroid disease exists) or antidepressants.

Childhood and teen depression needs to be dealt with promptly and appropriately to avoid serious consequences such as suicide. As we discussed in a previous post (October 13,2010) teens suffering from depression are more prone to believe “ending it all” is the only way to get out of the situation they perceive as hopeless or “not fixable”.

In my next post, we’ll explore behavioral therapy and the medications used to treat teenage depression in more detail.

Have you had a good or bad experience with a depressed child? If so….please share!

Dr. Frank

P.S. Remember our goal:  “to make the diagnosis and treat depression without confusing it for ADHD!”

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In my previous two blog posts this week, we’ve discussed the facts that:

• ADHD kids and teens are prone to depression
• All children and adults misdiagnosed and mislabeled as ADHD are also prone to depression
• Many children misdiagnosed as ADHD are really depressed and often go untreated
• All kids, teens and adults with depression are prone to suicide!

Unfortunately, it’s been my experience that suicide is much more likely if a teen’s depression is missed and goes untreated. Why?

• Teens have much more ready access to both legal and illegal drugs than younger kids
• Teens seem to suffer more with their depression and feel much more intense guilt and embarrassment than children and even adults
• Teens often either don’t fully understand  or can’t see a way to deal with their feelings and feel they are in a hopeless-no-win situation and are willing to do anything to get out
• Younger child don’t often recognize they are depressed and therefore don’t become as despondent
• Adults often recognize they have a problem and can see a way to fix it or at least get out of it even if it’s for short periods (Adult depression seems to cycle more than teen depression)

Here are some of the signs of teenage depression:

1. Poor concentration-if you’re depressed … guess what? You can’t focus well…just like an ADHD teen!

2. Poor grades… if you can’t concentrate, then….

3. Social problems….I’ve known depressed teens who lost every friend they had because no one wanted to be around them because of “bad karma”, “mood swings” or because she’s “a downer”.

4. A change in eating habits. Some depressed girls suddenly go from eating healthy foods to eating fast or junk foods for no apparent reason.

5. Legal problems… boys get caught speeding and reckless driving….girls might shoplift and use drugs or try sex for the first time.

These are just a few of the many signs and symptoms of teenage depression. You might want to visit www.adhdbehavior.com and take a look at the article; “Is My Fifteen Year Old Depressed” via this link: http://adhdbehavior.com/index/modules/wfsection/article.php?articleid=38

How Teenage Depression May be Confused with ADHD http://adhdbehavior.com/index/modules/wfsection/article.php?articleid=84

Next issue we’ll cover “making the diagnosis” and treating depression without confusing it for ADHD!

 Dr. Frank

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    In my last post, we discussed some of the reasons a child or a teen might get a tattoo or have an ear, tongue or nose piercing.  Usually, these behaviors not only irritate parents, but cause so much frustration and anger in both the parent and child that their relationship is often damaged for weeks or months.

It’s difficult for kids to talk with their parents and for parents to avoid yelling at their teenager when they obviously don’t agree that what the teen has done is either acceptable or intelligent.

Today we’re going to review other causes of these behaviors….plus talk about what a parent is supposed to do to deal with this problem behavior.

The most common reason for teens to get a tattoo or pierce their tongue, nose, eyebrows  or other body parts is to make themselves unique or so different that someone in their age group (or near their age) pays attention to the “new them” and recognizes and accepts them for what and who they are.

Other reasons include:

• The follow the leader syndrome (The teen wants and needs to be accepted into a group)
• True self-expression and the desire to be an individual with freedom of choices
• To deliberately irritate a demanding and controlling parent or guardian
• To seek parental attention (As my Uncle Frank always says: bad attention is better than no attention at all.)

So, what can a parent actually do once the damage has been done?

First of all, a parent must decide “Has there really been that much damage or is it something I can live with?”  After all, if it’s a tattoo, it’s not going anywhere. Currently, laser therapy to remove a tattoo runs about $1000 a square inch- ouch! If it’s a piercing, just removing the ring doesn’t close the piercing, which can cause $350 to $450 to do. (If piercing holes aren’t excised, they will eventually get infected or cause scarring!)

Others things a parent might want to do…

• Avoid destroying your lines of communication with your child
• Do not say mean or derogatory remarks about the behavior (What is the real difference between piercing your nose or say…piercing your ears?)
• Point out your reasons for disappointment (Unless you have a tattoo or piercing…then you’re stuck! You should not imply “Do what I say and not what I do!” Consistency and parenting by example are absolutely necessary to raise a child to a successful adulthood.)
• Remind your teen that you love them, care for them, want to protect them from all harm and are ultimately responsible for their behavior. This would be a great time to discuss the infections that can occur with tattoos and piercings, such as hepatitis B & C, HIV-AIDS, MRSA (staph) and fungal diseases. Additionally, you should discuss scarring, how difficult tattoo removal is and the possibility that tattoos and piercing might keep them from getting a good job.

A parent’s goal after-the fact should be to help the teen deal with what she or he has done, understand the implications of what has been done and reach the right decision about whether to get another tattoo… or another piercing in the future.

I’ll repeat the most important thing a parent should do…. Be a consistent, loving parent that reminds his or her teen that while you might not agree with their behavior and are disappointed with it, you still love them regardless.

If you have any other suggestions we can share about handling tattoo-piercing behavior in teens, please share.

Dr. Frank

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         One of the most common conditions confused with ADHD (I call these Zebras) seen in my office is bipolar disease, a condition in which wild mood swings can occur days and weeks at a time.  Often these kids are called “holy terrors” as their emotional outbursts can go from zero to out-of- control in a matter of seconds.  They make life miserable for everyone unfortunate enough to be around them when their swings occur. Moms dread taking them to places like the mall, the grocery store or to visit friends because they never know when they will act-out or cut-up. Some of these kids can be so difficult that even grandparents will refuse to babysit with them, effectively leaving the parents trapped and socially isolated.

 Such was the case with Heather, a twelve year-old who had been misdiagnosed as ADHD a year before visiting my office. In fact, she had been tried on five different ADHD drugs and all they did was make her behavior worse. Every time her mom explained this to her doctor, he increased her dosages because he believed she was not getting enough medicine.

After a thorough exam, including a psychological assessment, and blood work to rule-out other medical conditions that could mimic or look just like ADHD, her mom and I agreed to stop all of her ADHD drugs and see what happened.

I’m sure you can guess the result…. Heather’s mood swings decreased by at least 50%!

Heather was really bipolar-not ADHD! We started medication for Bipolar disorder, and within 3 weeks, her mood swings were almost gone. She was getting along better with everyone in her life-her classmates-her teachers-her brother- her parents-everyone.

Bipolar kids often suffer poor concentration and impulsivity just like children and teens with ADHD. Since their mind tends to race and go through fluctuating periods of good concentration and then bad concentration, they are often seen as: 
1. inattentive, careless, poor thinkers
2. impulsive, out of control, reckless, dare-devils
3. hyperactive, having explosive energy.

Sounds just like an ADHD kid-doesn’t it? 

Mislabeling bipolar kids with ADHD can harm their learning skill-set and ability to make and keep friends. You can learn more about Bipolar disorder and many more behavioral problems that might cause a child to be mislabeled as ADHD in my book; “Mistaken for ADHD”.
Dr. Frank

You can learn more about these ADHD zebras on my website ADHDbehavior.com. 
You might want to take a look at this news story about bipolar kids and possible misdiagnosis as ADHD:
http://www.helium.com/items/1963426-bipolar-disorder-teens

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