Expert: Joyce A. Anthony - 12/29/2006

Question
I am the foster carer for a fourteen year old boy.  He has severe emotional and behavioural problems that over the last five years we have been managing and seeing quite considerable improvement.  However over the last 6-9 months his behaviour has become more extreme.  He can be happy - singing and laughing - and then within an hour or in a terrible rage, swearing, hitting and breaking things.  He can then calm down completely and become loving and caring.  

He has been taking drugs for ADHD type symptoms - concerta and strattera.  His behaviour seems to have become more extreme since starting with strattera.

Does this ounds like bipolar disorder to you?
Are comments on the drugs?
Any advice you can give?

Many thanks

Rachel

Answer
Hi Rachel:

Very often ADHD and bipolar disorder come together.  They overlap in several areas so it is when a child is treated for only ADHD that the mania of bipolar disorder can be seen and diagnosed. While I am not qualified to give a diagnosis, it does appear that is what may be happening with your foster son.

My suggestion would be to contact the prescribing physician as soon as you have a chance and explain what you have been seeing since the addition of Strattera.  It is a good chance a mood stabilizer will be added.

When a child has both disorders, the common practice is to treat the mood disorder first.  This helps prevent medication-induced mania.  Unfortunately, bipolar disorder is often overlooked until ADHD medication sets off mania.

I have no personal experienmce with the two medications in question.  The best advice I can give is call your doctor as soon as possible and see about adding a mood stabilizer.

                               Joyce A. Anthony