I am trying to get an idea if diagnostic confusion of Aspergers and Bipolar is a common problem. I realized my 9 year old son had Aspergers features as young as 3. He is now 9 and is finally receiving an appropriate diagnosis of HFA or Aspergers (we'll find out which one next week). However, I subjected him to 3 1/2 years of bipolar medications because the doctors convinced me he had bipolar with Asperger's features. Any thoughts?
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I had never heard of diagnosing bipolar at that age. The severe meltdowns is what I think led to that diagnosis. Looking back, he most likely has HFA. He had some pretty significant behaviors in his younger years, but he always had excellent verbal skills (except when he actually needed something).
Joined: 19 Jul 2006
Well, I've already been diagnosed with AS but I still got the "Bipolar-NOS" label this past week. Mostly because of my meltdowns, I think. I seriously doubt that I really have bipolar, because I don't really get manic for extended periods. From my own experiences, I'd say "bipolar meds" aren't inherently bad for all people on the spectrum. I've been on Lithium and now Lamictal and neither has harmed me that much, and I think Lamictal has helped recently. But if the meds aren't helping or there are negative side effects, then by all means stop. A doctor who's familiar with the spectrum should help you sort these issues out.
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I feel there is a link, well we all seem to have mood swings etc... here are my thoughts including answer from Tony Attwood..
Mood swings (Bipolar) link to aspergers !
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First, I sure hope you won't blame yourself for your son's taking medications. You were trying to do what was best for your son. If he was put on medication at such an early age, my guess is that his symptoms were pretty severe at that point.
I am still learning about Asperger's, since I only recently learned that I have it. However, I do know a little about bipolar disorder, since I am being treated for bipolar disorder type II. From what I have read and discussed with my doctor, diagnoses of bipolar disorder and conditions like ADHD can be very difficult in children because the conditions can present with some of the same symptoms. I don't know if Asperger's shares any of those symptoms, but if it does, I can easily see where that would complicate the diagnosis and affect the treatment plan.
Even at age 9, I would be very cautious about diagnoses. Obviously, you need to let the doctors do their work and guide you to appropriate treatment for your son. On the other hand, the diagnoses are not carved in stone; they can change over time as more information about the condition becomes available. Unfortunately, psychiatry is not an exact science. Many times I wish it were, but the specialty and diagnostic tools have not advanced to a point where everything can be diagnosed with great clarity and absolute confidence.
If you have concerns about any long-lasting effects or after-effects of the medications your son was taking for bipolar disorder, I hope you will discuss them with his doctor. I hope that will put your mind at ease. This stuff is hard enough without other scary issues floating around to torment your mind.
I am happy for you that you are getting a diagnosis for your son that seems to fit.
All the best to you,
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Thanks you for your responses. I think Tony Attwood did a nice job of explaining the mood swing component. The funny thing about the medicines my son took is I think it made him worse. It would appear to help in the beginning, but after enough time passed I looked at his one day and noticed he had been stripped of his personality. He drooled a lot, which didn't help him with peers, and he had lost his quirky sense of humor.
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were the meltdowns more random seeming,or were there any setoffs,such as sensory problems,routine changes, changes to bedroom decoration/layout,unpredictibility,new clothes,new people etc ?
An aspie lady who lived at the last res. home am lived in,took tegretol for her mood problems [mood problems is too mild to describe it for her] if he needs a medication,that might be one to look at [there are quite a few].
Am have tegretol retard [the name for long release tegretol] and propranalol for severe meltdowns,don't know it self but staff say am have mood problems,they always find setoffs though.
And the drooling problem can be common with a lot of meds especially when they are at higher doses,am had it with gabapentin/neurontin,as it had completely numbed the side of face like a stroke,but it wasn't high dose.
Temple Grandin has said in her Thinking In Pictures book that medications often work differently in people with ASD,in that many need to have less than the normal dose,as the normal dose can be too high, some Auties and Aspies are hyper sensitive to medications whilst others are normal or hypo sensitive to them.
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He had meltdowns for various reasons. A change in routine while driving home, at age 3, let him to kick the door so hard he broke it. Telling him no. Definitely changes in routines set him off. Also, telling him that he couldn't bring toys into certian places (like no Poke-mon cards in church). He's always needed to carry toys or things with him, I think it was a comfort thing. He was increased to adult doses on: Abilify, Depakote, Lithium, and every simulant was tried. In fact the stimulants made him look very autistic (hand flapping, pacing, rocking) - all things he didn't do that often.
Joined: 23 Feb 2005
Location: Birmingham, UK
I believe that a LOT of Aspies, particularly those whose "verbal IQ" is normal to high (and therefore don't necessarily *seem* to have much of a problem with language, but just with emotions and social skills) get misdiagnosed with bipolar or similar labels.
While i was never diagnosed as bipolar, i was led to believe by stuff that i read that bipolar or something close to it was my "problem", before i found out about AS (which explained so many other things about my life in addition to my depression and relationship problems, while still pretty well explaining the latter, that it was just blatantly the right explanation, and made any additional labels superfluous).
"True" bipolar, AFAIK, is characterised by periods of depression and of mania that are months or even years in length, as opposed to the much shorter "cycle" of mood swings that i and most Aspies IME seem to have (OK, depression is a pretty constant presence in my life right now, but even when i don't have any major depression-causing circumstances in my life, i can still have mood swings from absolute euphoria to absolute despair, and even back again, in the course of a day). I believe some psychologists use the term "cyclothymia" to refer to depression/euphoria cycles which are shorter-term and less "absolute" than those of bipolar proper, although the same medications often get prescribed, as the mood-altering medications available mostly treat "symptoms" rather than the underlying cause.
I think the depression and anxiety suffered by almost all Aspies is reactive depression and/or PTSD from a lifetime of misunderstanding, miscommunication, sensory overload and unconscious discrimination, rather than being due to any sort of chemical/internal cause (which doesn't mean that Aspies and people with bipolar or other forms of "endogenous" depression shouldn't be comrades in the disability rights and neurodiversity movements, just the issues are distinct, and can't be conflated into one set of either "totally chemical" or "totally social" issues).
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^^^ THAT sounds like autism or AS.
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I have sort of bipolar like moods but that is expressed in hyperness and excitement.
Bipolar does not equal meltdowns, which indicate sensory overload or an adverse reaction to change.
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No, not necessarily. The main difference between bipolar proper and cyclothymia is not the duration but the severity of the episodes. In cyclothymia, the affective phases are mild and never reach the psychotic level (typically, hypomania will be experienced as a period of rejuvenation, joy and enhanced creativity, while subdepression will feel as a period of sluggishness, apathy, reduced creativity and capacity for work, and (usually) sadness), though of course during each of them there can be occasional swings in the opposite direction, since individuals with cyclothymia tend to be quite sensitive and easily "catch" good or bad moods from others.
It is also not necessary for bipolar episodes to last many months or years - actually, the most common course includes episodes of three to five months (if an episode does last over a much longer time, it is usually the depression, and only extremely rarely the mania). And ultra-rapid cycling where the phases change in a matter of weeks, days or even over a single day is definitely a sign of bipolar proper, not cyclothymia, and not a very good sign either.
There is no real line dividing bipolar and cyclothymia either. Individuals who have cyclothymia often develop bipolar later on in life, and when one has bipolar, one may also continue to have cyclothymia-scale episodes inbetween the more severe ones.
As far as I know, there is a high co-morbidity between ASDs and affective disorders of whatever kind, but I do agree that it may be difficult to distinguish between an endogenous affective disorder and depression brought on by isolation and ostracism, or, alternatively, euphoria caused by absorption in a special interest.
I was myself diagnosed with bipolar several years ago, and, frankly, I have very little doubt about it. The long debilitating spells of depression and short bursts of mania are quite obvious and I can definitely feel their impact on my life (as it is, I've developed plenty of coping mechanisms which help me continue to function with mild depression most of the time). There could be some debate as to whether it's bipolar vs. schizoaffective disorder, or pure bipolar vs. bipolar combined with schizotypal personality disorder, but affective disorder vs. no affective disorder - no, not really.
Joined: 3 Apr 2007
As Professor Attwood said, those with Asperger's have trouble with managing, defining/recognizing emotions, and simple triggers can send us spiraling down the emotional staircase in an instant. We can "bounce" back from such quickly enough as we then reabsorb ourselves in our interests/whatever when the event/trigger is removed.
I recognize this within myself; I really don't know how I'm feeling at the time, unless I'm sad or scared, I seem to understand them easily enough.
Bipolar is periods of the same emotion (a few months or so for each); severe depression to mania in the stereotypical case of.
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