Children and Teens With ADHD and Depression

Parent of children with ADHD must pay attention if their child’s behavior changes. Sometimes when a very active child becomes more quiet, their parents believe this is a good sign because the hyperactivity is subsiding. Unfortunately their child could be exhibiting symptoms of depression.

In fact, children and teens with ADHD are at risk for developing depression as much as 3 times greater than for other children. As many as 25% of teens with ADHD are depressed. Research points to two underlying factors that can trigger depression in children or teens with ADHD.

Depression shares certain symptoms with ADHD, such as inability to concentrate, mood swings, irritability and agitated behavior, making it difficult to know whether a child is suffering from depression, ADHD or both. Seek professional help for an accurate and timely diagnosis.

We can assume that many children with ADHD experience daily negative feedback from parents, teachers, bus drivers and even their peers lowering their self-esteem. This constant feeling of malaise with the world around them, results in enough stress, frustration and anger that they can be driven to depression.

But the depression is not only cause by demoralization that can result from the day to day struggles of dealing with ADHD. Research has suggested that depression in children and teens with ADHD is a co-morbid disorder. ADHD and depression co-exist and have to be both treated separately

Parents must be vigilant to note any changes in their child with ADHD because the depression must be attended to. Some changes and behaviors that should trigger an alarm bell are:
*No energy or fatigue nearly every day
* Stops talking, withdraws from the family by retreating into his/her room
* Odd sleeping patterns , insomnia or hypersomnia nearly every day
* Constant low, depressed or irritable mood most of the day
* Overly emotional over trivial matters, frequent mood changes
*Loss of interest or pleasure in almost all activities
*Changes in eating habits accompanied by significant weight loss or weight gain
*Tearfulness or frequent crying
*Feelings of worthlessness, inappropriate guilt
*A strong sense of not being understood and approved of by parents, siblings, or peers
*Feelings of wanting to leave home, wanting to run away
*Recurrent thoughts of death and/or suicidal thoughts

 At the first signs of depression seek professional help. Left untreated, depression can lead to problems at home and school, drug abuse, self-loathing and escalate from there. It is a fact that untreated depression is very risky and potentially fatal.

Take action right away. The parents and other adults in a child's life must intervene because the child does not understand what depression is and he does not realize that how he is feeling in not the norm.

A professional evaluation is needed to distinguish between normal moodiness, ADHD symptoms and depression. Depression does not go away by itself. With proper diagnosis and treatment a depressed child or teen can be greatly helped.

Always keep open lines of communications with your child, your child's friends and teachers. Parents and teachers working together, with the child following a professional’s counsel, is the only way to assure your child will get all the guidance and support he needs for both his ADHD and depression

What were the first symptoms you noticed when your child or a child you know became depressed?

The Depressing Facts About Juvenile Bipolar Disorder

Derryck Smith, head of psychiatry at the Children's and Women's Health Centre of British Columbia, wrote in the Canadian Journal of Psychiatry last July: "There is no greater controversy in child and adolescent psychiatry than that related to the diagnosis, treatment and increasing prevalence of childhood-onset bipolar disorder."

While the debate rages on, parents and children struggle on. The following facts do not paint a pretty picture of the situation. Doctors, researchers and experts at children's hospitals, mental-health support groups and referral services must push for answers and programs to help families crippled by Juvenile Bipolar Disorder.

The Depressing Facts:


*Some psychiatrists suspect that under broad definitions, childhood bipolar disorder may be more prevalent than autism - affecting between 1 and 2 per cent of all children.


*Bipolar disorder was thought to be the result of chemical imbalances in the brain, now researchers can also identify specific areas of the brain that are affected by the illness.


*According to the Child and Adolescent Bipolar Foundation, 15% of children diagnosed with ADHD may actually be bipolar.


*Many of the frustrating or objectionable behaviors displayed by students with bipolar disorder are actually symptoms of neurological instability in the brain rather than willful misconduct.


* The disorder is often suspected by a knowledgeable parent, psychiatrist, pediatrician, psychologist, therapist, or social worker based on information and observations from the patient, family members, and others who know the child well.


*A correct and thorough evaluation as early as possible is critical since psycho stimulant medications, often prescribed for ADHD, may worsen manic symptoms of juvenile bipolar disorder.


*According to the Child and Adolescent Bipolar Foundation (CABF), children with bipolar disorder can be charming and charismatic during an appointment. They initially may appear to a professional to be functioning well. Therefore, CABF suggests you take daily notes of your child's mood, behavior, sleep patterns, unusual events and statements made by your child that cause you concern. Share these notes with the child and adolescent psychiatrist who you choose to evaluate your child.


*Bipolar disorder tends to run in families. When one parent has bipolar disorder, the risk to each child is estimated to be l5-30%. When both parents have bipolar disorder, the risk increases to 50-75%.


* Juvenile Bipolar disorder has always stood out as one of the toughest psychiatric disorders to diagnose, manage and monitor because of the ultra-ultra rapid mood swings of mania and depression and the other comorbid conditions.


*Health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.

*Research suggests the earlier the disease strikes, the more severe the illness will become.

*Bipolar children are at risk for failing grades and drug abuse. Prone to suicide, reckless behaviour and delusions of grandeur, no mental illness results in more premature deaths than bipolar depression.

An Educator's Guide to Pediatric Bipolar Disorder February 5, 2010, on the Child and Adolescent Bipolar Foundation website gives this advice:

"A child with bipolar disorder needs medical treatment, but medication is just one element of an effective treatment plan. It is equally important for the child to be surrounded as much as possible by supportive people in settings that minimize daily stress.

 An effective treatment plan for bipolar disorder requires three essential elements:

• Medication

• Lifestyle and environmental changes

• School accommodations

Bipolar disorder is a chronic, lifelong condition. However, medications can help alleviate and reduce symptoms so they are less intrusive, smooth out mood fluctuations, reduce anxiety and distractibility, and increase frustration tolerance. Because stress is a trigger that intensifies bipolar symptoms and causes a decline in overall level of functioning, lifestyle and school changes should be made to reduce stress."

As grim as all this sounds, focus on the big picture. Create opportunities for your bipolar child to shine and feel good about him/herself…this little star has talents, gifts and a whole life ahead that you are instrumental in making  happier and brighter. "If you think you are too small to be effective, you have never been in the dark with a mosquito”

Leave us a comment telling us the support or services in your area for families affected by Juvenile Bipolar Disorder.

What Are Some Symptoms of Juvenile Bipolar Disorder?

When Bipolar Disorder is finally diagnosed in an individual, parents will most often confess that since their child was a toddler, they KNEW something was not just right.  Since toddlerhood, their child had had a very difficult time to settle for the night, had extreme difficulty sleeping through the night, experienced severe separation anxiety and had always had lots of sensory issues.

The visits to their professional support had probably been in vain as all the above complaints could be attributed to many causes. These parents are not alone because it is a fact that Bipolar Disorder is often misdiagnosed or overlooked.

The Juvenile Bipolar Research Foundation website states that Bipolar disorder (manic-depressive illness) affects close to 1 million children and adolescents in the United States at any given time. Recent studies have found that from the time of initial manifestation of symptoms, it takes an average of ten years before a diagnosis is made. This is due in part because its symptoms overlap those of other disorders, including ADHD, depression, or obsessive-compulsive disorder.

What is different between adult and juvenile bipolar disorder?

In adults, the mood cycles of mania and depression can last several days or weeks. In children, the cycling pattern is called ultra-ultra rapid. Their moods fluctuate multiple times in a day. These children seem to have problems getting going in the morning and have more active moods in the afternoon and evening.

The following are other Red Flag signs of juvenile bipolar disorder:

*Children appear hyperactive, fidgety, frustrated, inattentive, restless …these symptoms are much like ADHD but add to this the following symptoms.

*Children have decreased need for sleep, will sleep only 4-6 hours and are not tired the next day. Bipolar kids tend to experience a range of sleep disturbances that include night terrors and nightmares - often with images of gore and mutilation and themes of bodily threat and parental abandonment - sleep-walking, teeth-grinding, and bed-wetting.

*Children have grandiose behaviors ~an inflated self-esteem or think they have special powers, like Superman. Children act as if rules were not made for them and take unbelievable, dangerous risks.

*Children will suffer high levels of frustration. The word “NO” will make them throw a temper tantrum that lasts a long time. These tantrums may even be accompanied with aggression. All these negative behaviors may never be shown outside the home. Or for some children, it is the exact opposite where parents see their good sides and the school sees their violent side.

*Children have flight of ideas and jump from topic to topic becoming unusually talkative and talk faster than usual.

*Children may be unreasonably silly, giddy or happy.

* Children have sudden shifts in mood making them bored, withdrawn, wishing they were never born. And yes, children can even be suicidal.

*Children may be bossy to their peers and even to adults. Some children can be insolent but other children are well-liked and want to make friends. Some will have difficulty making transitions and become argumentative.

*Children develop social phobia and want to be alone. They loose interest or pleasure in activities they normally enjoyed. They feel tired, worthless and guilty about unreasonable things.

*Some children even have hallucinations, they see insects or snakes, hear voices, or hear satanic figures. Some have delusions (irrational fears or beliefs).

In another post I will tell you about the Fear-of-Harm phenotype (FOH). This group of children have a more severe form of pediatric bipolar disorder with higher frequency and severity of manic and depressive symptoms, greater rates of hospitalization and greater likelihood of school performance difficulties.

If any of these RED FLAGS make you think your child has bipolar disorder DO NOT WAIT. Seek professional help immediately and do not stop until the right care has been found for your child. The first line of treatment is usually to stabilize the child's mood and to treat sleep disturbances and psychotic symptoms if present.

The following sites are a wealth of information for parents…use them, arm yourself with knowledge to advocate for your child. When my child was struggling through undiagnosed bipolar disorder, none of this was available.

Resources

National Alliance for the Mentally Ill (NAMI)

1-800-950-6264,  http://www.nami.org/

Mental Health America a change of name from (National Mental Health Association (NMHA)

1-703-684-7722, http://www.nmha.org/

Child & Adolescent Bipolar Foundation (CABF)

1-847-256-8525, http://www.bpkids.org/ or http://www.cabf.org/

Juvenile Bipolar Research Foundation (JBRF)

http://www.bpchildresearch.org/

Depressive & Bipolar Support Alliance (DBSA)

1-800-826-3632, http://www.dbsalliance.org/

Bipolar Children Newsletter

http://www.bpchildren.com/

Parenting Bipolars: A Survival Guide for Parents

http://www.parentingbipolars.com/

Personal Reason to Rejoice About New Study on Tourette Syndrome

While searching Google for the simplest way to describe Tourette Syndrome, I had a flash back to fifteen years ago when I received a frantic call from our

daughter at the University of Ottawa announcing that she had been diagnosed with TS. Immediately after the call, I rushed to research what was Tourette. For years we had sought answers and treatments to help our attractive, above average, intelligent daughter deal with the demons crowding her life.

My search, those many years ago, finally let us understand what our daughter had to confront every day and night. Living in a rural Nova Scotia area with hardly any professional support, we struggled through her childhood and through her teen years. Finally specialists in the Ottawa area had but an end to our questioning and had given us a diagnoses to explain our life coping with unknown symptoms. That day, I learned another new word: other comorbid conditions. The same struggles continued, only now we had names for these demons.

Wikipedia tells us: “Tourette syndrome, or simply Tourette's or TS is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane. Obsessive–compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) are often associated with Tourette's.

Undiagnosed comorbid conditions may result in functional impairment, and it is necessary to identify and treat these conditions to improve functioning. Complications may include depression, sleep problems, social discomfort and self-injury.” With these symptoms challenging their every day, you can see why news about a possible break in the search for treatment of TS is very exciting.

A study, led by Matthew State, M.D., published in the New England Journal of Medicine by Yale School of Medicine researchers May 5th 2010, gives hope for treatment of Tourette syndrome (TS).

The Yale researchers worked with a father and all eight of his children who had Tourette syndrome. The State lab took DNA samples of all members of this family and were able to identify a rare mutation in a gene called 1-histidine de carboxylase (HDC) in the samples from the TS members. This gene makes a protein that is required for the production of histamine. Histamine has a role in allergic response and is also a neurotransmitter that influences a variety of brain functions. They found that the mutated protein lost its function.

Strong evidence, that genetic mutations contribute to TS, had lead researchers in this direction for over a decade. Dr. State said that past work on brain histamine by other labs shows that mice with low levels of histamine are more prone to repetitive behaviors that are similar to human tics, and that increasing brain histamine reverses this problem.

"We were lucky to happen across a gene pointing to a well-studied area in neuroscience, pointed out State. There are several new medications in development that increase the release of brain histamine. Based on this genetic finding, these compounds would be good candidates for new treatments for Tourette."

As you can see, Tourette, like many other medical conditons, has many facets and grey areas for which the medical community has no answers. Let us hope the above gene mutation study results in real, long awaited answers …it was in 1884 that Gilles de la Tourette, using the name "maladie des tics", first described the symptoms and in his honor the illness was given his name.

Looking for more posts on Tourette? Check out:

Nix Your Tics! Eliminate Unwanted Tic Symptoms by Duncan McKinlay

Tourette Syndrome ~ Your Child, His Tics and School


Has your family been affected by Tourette Syndrome?

Teen’s Lack Of Sleep May Be Cause Of Depression

Lack of sleep is not just a symptom of Depression but studies show it can either cause or worsen it.

In the Jan.1, 2010 issue of SLEEP, researchers at Columbia University found a strong link between lack of sleep and depressive symptoms in adolescents. SLEEP is the official publication of the Associated Professional Sleep Societies, LLC (APSS) a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society... to read  more  

 Parents cannot force their teen to sleep but setting earlier bedtimes helps and seems to have a protective effect. Most teens need about 8½ to more than 9 hours of sleep each night. The study found that adolescents with parental set bedtimes of midnight or later were 24% more likely to suffer from depression than adolescents with parental set bedtimes of 10:00 PM or earlier.

However, earlier parental-mandated bedtimes must be accompanied by lifestyle changes that will facilitate the teen to fall asleep.

*Schedule enough time to relax before the agreed upon bedtime.

*Teach your child how to handle stress so he does not carry his worries to bed.

*Encourage your teen to participate in daily physical activities inducing adequate quality sleep.


*Remove all electronics from the bedroom: computer, television, phone, cell phone, video games…


*Eliminate drinking coffee and other drinks and food with caffeine and sugar late in the day.


*Encourage your youth to eat balanced meals


Studies can state facts and findings, parents can state rules and repercussions, but no one can wave a magic wand and make a teen fall asleep. You and your teen have to want this or it will not work. Like all other matters in life, ensure this problem is tackled early and prevent serious mental health conditions such as depression which are much more difficult to deal with.


What advice can you share on how to assure your teen gets the required hours sleep?