Coping With a Dual Diagnosis While Residing In a Residential Facility: Bi-Polar Disorder & ADD in Adolescents
Both Bi-polar and ADD Disorders are the conditions that make it hard for the person, especially when he or she is in his or her teens, to fit into the preferable behavioral patterns existing in the society. But when those two disorders combine the life of the patient and his/her surroundings may become unbearable, unless certain measures are taken for to help the adolescent cope with the unwanted behaviors.
For to understand how to cope with this dual diagnosis we first have to give the definition for both of this disorders and get acquainted with the symptoms that characterize these conditions. Then we will get acquainted with the behavioral patterns typical for these disorders, and discuss different aspects of life, relationship and treatment of adolescents that suffer from a combination of the Bi-Polar and ADD Disorders.
Let’s begin with the definition of the Attention Deficit Hyperactivity Disorder (ADD). Some scientists state that ADD is “a brain-based biological disorder caused by a brain chemical imbalance”. But the thing is that the scientists still haven’t found a method to diagnose ADD as a medical disease. No physical or chemical abnormalities are found in the organisms of people suffering from this disorder. Thus for to put this diagnosis the doctors use a checklist of symptoms. In case person has at least some of those, he/she is diagnosed with an attention disorder. (Attention Deficit Disorder, 2000).
Hallowell and Ratey in their book Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood defined ADD as one of the attention disorders. People who have this disorder experience problems when the try to focus and maintain attention.
Bi-Polar disorder, which is also known as a manic-depressive disorder affects more than 2 million American adults, and, according to the data provided by the American Academy of Child and Adolescent Psychiatry, something about 1,1 million of American children and adolescents may be suffering from the Bi-Polar Disorder.
David J. Miklowitz in his book The Bipolar Disorder Survival Guide states that he peak age of onset is between 15 and 19, and 20% of all patients suffering from this disorder have their first episode in adolescence. It is also that approximately 16% of all the patients of the child psychiatry clinics probably have this disorder.
The Bi-Polar disorder is underdiagnosed both in children and adults. For children adolescents the reason is that the symptomatic is not very well established in them, that the symptoms of the Bi-Polar disorder can be mistaken for the symptoms of the other disorders, and that sometimes even the healthy children show the signs of the Bi-Polar disorder. (Suppes, Keck, 2005)
The Psychological Glossary of the Online Psychological Association Website defines Bi-Polar disorder as a:” Formerly called “Manic-Depressive Illness,” a mood disorder characterized by severe alterations in mood which are usually episodic and recurrent. At least one mood episode must be of the “manic” type, in which a person experiences either extreme elevation in mood (euphoria) and energy level, or extreme agitation and irritability. In addition, episodes of depressed mood are usually present”.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition be American Psychological association gives three main symptoms of the ADD Disorder. Those are: inattention, impulsivity, and hyperactivity. For to be diagnosed with the ADD Disorder, the patient needs to exhibit at least six of the symptoms for inattention, or at least six of the symptoms of the combined hyperactivity-impulsivity list.
SYMPTOMS OF INATTENTION
a. often ignores details; makes careless mistakes
b. often has trouble sustaining attention in work or play
c. often does not seem to listen when directly addressed
d. often does not follow through on instructions; fails to finish
e. often has difficulty organizing tasks and activities
f. often avoids activities that require a sustained mental effort
g. often loses things he needs
h. often gets distracted by extraneous noise
i. is often forgetful in daily activities
SYMPTOMS OF HYPERACTIVITY-IMPULSIVITY
a. often fidgets or squirms
b. often has to get up from seat
c. often runs or climbs when he shouldn’t
(in adults, feelings of physical restlessness)
d. often has difficulty with quiet leisure activities
e. often “on the go”, as if driven by a motor
f. often talks excessively
g. often blurts out answers before questions have been completed
h. often has difficulty waiting his turn
i. often interrupts or intrudes on others (APA, 1995)
As for Bipolar Disorder there are several types of it, determined by the severity of symptoms, frequency of episodes etc. Bipolar I disorder is characterized by one or more manic episodes or mixed episodes (symptoms of both a mania and a depression occurring nearly every day for at least 1 week) and one or more major depressive episodes. Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes.
Bipolar II disorder is characterized by one or more depressive episodes accompanied by at least one hypomanic episode. Hypomanic episodes have symptoms similar to manic episodes but are less severe, but must be clearly different from a person’s non-depressed mood. For some, hypomanic episodes are not severe enough to cause notable problems in social activities or work. However, for others, they can be troublesome. (Geller, Delbello, 2003)
Kahn, Ross and Printz state that ” Mania often begins with an intense burst of energy, creativity, and social ease. People with mania typically deny that anything is wrong, and angrily blame anyone who points out a problem.” Manic episode is characterized by:
needing little sleep yet having great amounts of energy
talking so fast that others cannot keep up with the thought pattern
having racing thoughts
being so easily distracted that their attention shifts between many topics in just a few minutes
having an inflated feeling of power, greatness, or importance
doing reckless things without concern about possible bad consequences (eg, spending too much money, engaging in inappropriate sexual activity, or making foolish business investments)
The symptoms last for at least a week. In severe cases, the person may also experience hallucinations or delusions.
Hypomanic Episode: Similar to a Manic Episode, except that delusions or hallucinations are not present. Also, the mood during a Hypomanic Episode must be clearly different from the individual’s usual nondepressed mood, with a change in functioning. The change is observable by others, but not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. No psychotic symptoms. (APA, 1995). The symptoms are similar to the manic episode, but less severe and last for no less than 4 days.
Major Depressive Episode: When 5 or more symptoms of depression (are present during the same 2-week period and at least one of the symptoms is depressed mood or loss of interest or pleasure. (APA ,1995). The symptoms of the Major Depressive Episode are:
· Feeling sad, blue, or down in the dumps or losing interest in the things one normally enjoys
Plus at least 4 of the following symptoms:
· changes in appetite or weight
· changes in sleep
· difficulty thinking, concentrating, or making decisions
· feeling slowed down
· feeling worthless or guilty
· thoughts of death or suicide
There are some peculiarities in the behavior of both the ADD patients and those, who suffer from the Bipolar disorder. One of it is this is that the ADD adolescents usually suffer difficulties understanding the sequence of events that happen around them. As they don’t see why one behavior follows another, they often cannot explain the reasons for their actions. The ADD people can concentrate their attention only on one action, thus when they for example, watch TV they don’t hear the phone calls or forget to have a lunch.
The ADD adolescents and children have a tendency to hyperfocus, and they spend a lot more energy on concentration than the normal people do. It explains his/her aggressive behavior when the ADD adolescent is distracted from the activity he/she is engaged in. He/she cannot stop spending this energy at the moment he/she is distracted, thus it spills in the outburst of physical or verbal aggression.
There are also specific behavioral patterns of adolescents, suffering from the Bi-Polar disorder. In contrast to the adults, who tend to be euphoric or elated during the manic or hypomanic episodes, adolescents are usually prone to destructive outbursts and irritable. During the depressive episodes adolescents often have physical complaints, such as headaches, tiredness, or muscle aches. The depressed adolescents perform at school poorly; tend to run away from home, they suffer from social isolation, extreme sensitivity to rejection or failure etc. The Bipolar adolescents often tend to solve their problems by alcohol or substance abuse.
The data exists that 19% of the Bipolar adolescents also suffer from ADD/ADHD disorder. (Kane). Adolescents, who experience both of those conditions, should be treated very carefully, as the evidence exists that the medications used for to treat ADD worsen the manic symptoms. The doctors also say that sometimes the symptoms characterizing ADD/ADHD are the forerunners of the full-blown mania. (What is Bipolar Disorder?, Focus Adolescent Services Website)
The relations with the surroundings for those adolescents are usually very complicated. The fact that those teenagers have problems concentrating on the communication with the specific person doesn’t allow them to establish close relationships, and the mood swings, which are triggered by the sequence of the manic and depression episodes often scares people off the adolescent.
The usual teenager problems only worsen the condition of the adolescent, as he/she feels himself/herself rejected, and the surroundings only confirm the apprehensions of the patient. For the adolescents studying is often the only way to maintain his/her social status, and the ADD teenagers with the Bipolar disorder usually has big problems at school because of the lack of concentration, the failure to understand the sequence of events, and the lack of desire to study.
Love relationships are also the matter of concern for the adolescents, and the person with these problems has problems establishing close contacts. The behavior of the ADD and Bipolar adolescents often seems strange and inadequate to the other people, some of the peculiarities in their behavior make others think they are lying most of the time, and it cannot be the basis for the happy relationship. Thus those adolescents feel themselves rejected and loveless, and, in the addition their failure to build successful love relationship lowers their social status among the coevals.
As we’ve already noted studying is one of the main means to establish social status for the teenager, and the person with these disorders cannot study successfully. Even those teachers that know about the specifics of these disorders sometimes cannot cope with the teenager’s negative behavior. Thus most people at school consider this child to be a problem, and treat him/her accordingly. Considering that these teens are extremely sensitive to rejection or failure, they usually don’t like to visit school.
When the ADD and Bipolar person is still in his or her childhood his/her parents solve all the problems and difficulties that appear. But when the person grows up he/she has to stand for himself/herself, and for child with these condition it is much harder than for the healthy individuals. It is usually that all the people the adolescent have to contact with know about his/her condition and treat him/her accordingly, but when the young person has to visit some official organizations he/she has to interact with employees that see him/her first time in their lives, and who aren’t informed about the child’s condition.
At this stage numerous misunderstandings and conflicts usually occur, as the adolescent’s behavior seems inappropriate to them, thus he/ she cannot reach the goal which led them to the establishment. After few such cases the ADD and Bipolar adolescent refuses to contact with the official organizations, which creates numerous problems both for him/her and his/her parents.
It is also that the ADD and Bipolar adolescents often get so used to the fact that their parents solve all the problems for them that they are unable to lead the independent lives. For example it’s almost impossible for such a child to get the college degree, as at this period of the person’s life parents aren’t able to help their child to maintain the schedule and cope with their emotional state. One more problem for such people is finding a job, as no employer wants to work with a inattentive person with the mood swings.
Raising a child with any of these disorders is not an easy task, but coping with an ADD and Bipolar teenager is even worse. The thing is that the most part of attention in the family is devoted to the sick child. His/her siblings, and sometimes even fathers, begin to be jealous to teenager. His/her behavior only adds up to the negative emotions. The outbursts of physical and emotional violence, hysterics, mood swings and inattentiveness make the relatives of the child feel angry and helpless, and it provokes even more negative behavior.
It is also that the members of the family compare their child/grandchild/brother or sister to the other people of his/her age and gender, and find that his/her behavior is inappropriate. They suffer from the fact that their child is unable of getting the social status the other people have, and they sometimes feel he/she will never be happy.
The relationship between the ADD and Bipolar adolescent and his/her social worker are also often complicated. The first thing is that such adolescents rarely trust anyone except of their immediate family, and at the beginning of the relationship the child is afraid of the social worker and thus isn’t cooperative.
The next point is that those teenagers really need discipline for to make their physical, emotional and social condition better, and the ADD and Bipolar adolescents don’t like to be disciplined. They usually allow their parents and teachers to control their behavior, but the social worker has to earn this right. Another problem is that when the teen accepts the social worker as someone who can discipline him/her the desire for cooperation vanishes.
When working with a ADD and Bipolar adolescent the social worker has to be very careful for not to offend the feelings of the teen, and in the same time, earn at least some authority in the teen’s eyes. These teenagers usually meet incomprehension everywhere except for the family, and the social worker has to break this stereotype. The social worker’s main challenge is to point the adolescent that his condition is at first possible to live with, and, second, controllable.
The ADD and Bipolar teens usually suffer from the fact that they don’t have the things their coevals have, and the social worker has to point the ways to his clients to reach the goals he/she has. The social worker’s task is to help the adolescent develop his/her own ways of troubleshooting and goalscoring, different from those the ones other people use.
The adolescents who suffer from these disorders suffer a lot of inconveniences with the societal interactions, but there also strength those people have. One of their main bonuses is that when they actually manage to concentrate on some task, they perform it better and more quickly than the ordinary person would. Their abilities for concentration are greater than the healthy people have and it makes their work more effective in some cases.
In the addition people with these disorders are often very creative. In the condition of the weak contact with the surrounding world they are capable of creating beautiful music, poems, novels etc. Those people are also known for the spontaneity of their decisions and the creative approach to the problems they have to face, thus they are more effective in some situations than the ordinary ones.
One more positive quality of those people is that they usually possess great empathic skills; they are very compassionate and caring. Their ability to concentrate on the problem totally makes them the good listeners, as when you finally manage to get their full attention you are sure to have until you are finished with your speech.
Rosemary Boon in her study of the ADD/ADHD Disorder also found that those people have more tolerance towards the elements of chaos than the healthy individuals do. It makes them the best candidates for the positions where quick reaction and troubleshooting is required.
The life of a child who is raised by a drug addicted mother is always traumatizing. The kids whose mothers used drugs during the pregnancy are often born with various problems, and ADD is one of them, as Frank Lawlis notes in his book The ADD Answer : How to Help Your Child Now. Smoking marijuana and using cocaine increases the risk of the birth of the ADD child.
We can conclude that the life of the adolescent with these two disorders is not an easy one. The teenager and his parents have to cope with various problems every day, but these conditions are not incurable or uncontrollable. If the patient wants to make his/her condition better numerous kinds of therapy exist for to help them achieve it. The ADD and Bipolar adolescents actually can have a happy life; they just have to put more time and efforts for to achieve it.
Sorry, forgot the reference list in the previous draft. Here it is J
n.d. Attention Deficit Disorder. Focus Adolescent Services Website, 2000. Accessed 18 November, 2005 http://www.focusas.com/AttentionalDisorders.html
Hallowell , E. Ratey, J. Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood. Sound Ideas, 1995
Miklowitz, D. The Bipolar Disorder Survival Guide: What You and Your Family Need to Know. The Guilford Press, 2002
Suppes, T. Keck, P. Bipolar Disorder: Treatment and Management. Compact Clinicals, 2005
The Psychological Glossary. Online Psychological Association Website. Accessed 18 November, 2005 <http://www.ohpsych.org/Public/glossary.htm>
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Text Revision. Washington, DC: American Psychiatric Association; 2000
Kahn DA, Ross R, Printz DJ, Sachs GS. Treatment of bipolar disorder: a guide for patients and families. Postgrad Med Special Report. 2000(April):97-104.
Bipolar Disorder in Childhood and Early Adolescence. Geller, B. (Ed), Delbello, M. (Ed). The Guilford Press, 2003
Kane, A. Helping You with Your Bipolar Disorder Child. ADD ADHD Advances Website. Accessed 18 November, 2005 http://addadhdadvances.com/bipolar.html
Boon, R. ADD & ADHD – Attention Deficit Disorder & Attention Deficit Hyperactivity Disorder. Accessed 18 November, 2005
< http://home.iprimus.com.au/rboon/ADDADHD.htm >
Lawlis, F. The ADD Answer : How to Help Your Child Now. Plume, 2005