Bi-Polar Disorder, or Manic Depression, is characterized by mood swings, sometimes extreme, ranging from depressed to normal moods, or from depressed to manic episodes. Manic behaviors are often very similar to "hyperactive" behaviors, including motor restlessness, irritability, temper outbursts, sleeping less, or having higher levels of energy. It is rare. But it does happen.

About three times per year a child is brought to my office for an assessment for ADHD who ends up having "Early Onset Bi-Polar Disorder." These children are typically displaying very extreme behaviors, such as throwing their bicycle -- off of the roof -- at the policemen who have been called, and so on. (When I received that call I wasn't sure what to ask first. "What was he doing on the roof with his bike?" was the best I could think of. "He was going to ride off of the roof, of course." was the answer from the child's mom.)

The behaviors may not be constant or consistently displayed as one might expect from an ADHD child, and may be more extreme than one would expect from ADHD.

The big clue is taking a family history and seeing if either of the parents, their brothers or sisters, or their parents, have/had a bi- polar disorder. If so, then this clue will be very helpful in making a proper diagnosis. I usually refer families to UCLA for a better evaluation, but in your community you may need to rely on an evaluation by a very good psychiatrist (never go to a bad or even average psychiatrist, only good ones!). Ask about experience with bi-polar disorder in children.

Telephone teaching hospitals in your area if there are any, or call your local private psychiatric hospital. Don't ask the switch board operator for a referral, instead ask for the children's unit or the adolescent unit. Once transferred there, ask the unit nurse who they would recommend ("If it were your child, who would you take your child to see?") The nurses know.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.