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My teen is extremely moody. Is it ADHD or bipolar disorder?

The question: My teen is extremely irritable and moody, which can be symptoms of ADHD or bipolar disorder. How can I tell the difference and what are the warning signs?

The answer: As the father of two teenage daughters, I can speak from first-hand experience on the subject of teenagers and moodiness. The teen years are a turbulent time influenced by hormones, peer pressure, poor nutrition, and disrupted sleep patterns.

It is no surprise that mood swings and irritability are common, and even the most even-tempered child can suddenly become a sabre tooth tiger with little or no provocation. This is to be expected and is normal adolescent behaviour. It is worth remembering that these mood swings are frequently irrational, unexpected, and often beyond the control of the teen.

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You are correct in identifying moodiness as one of the symptoms that can be seen with both ADHD and bipolar disorder. Fortunately, these conditions have other classic symptoms that help distinguish them from normal teen behaviour.

ADHD or ADD, is short for attention deficit (hyperactivity) disorder. This very common disorder usually presents in the elementary school years but can have symptoms that are lifelong. The typical features of ADD include an inability to focus and concentrate, impulsive behaviours, and being easily distracted. Almost always this affects a child's ability to perform as expected in the classroom. These children are also often impatient, disorganized, and forgetful. Although some youngsters may be restless or have difficulty sitting still, not all children will have prominent hyperactivity. Moodiness can accompany these core symptoms of ADHD and can also been seen as a side effect of some of the medications used to treat this condition. Mood swings by themselves, however, are not indicative of ADHD.

By contrast, bipolar disorder is relatively uncommon in children and teens. Its symptoms can vary significantly from one teen to another but usually involve a period of depressed mood, with disrupted eating and sleeping patterns, feelings of worthlessness, and social withdrawal. Almost always, academic performance is affected, and teens start to pull out of their usual extracurricular and social activities. Moodiness, tantrums, and aggressive behaviour can certainly occur, but are accompanied by a significant disruption of the adolescent's normal daily routine and social activities. Young adults suspected of having bipolar disorder should be further assessed by a mental health professional such as a pediatrician, psychologist or psychiatrist.

Other conditions to consider when your teen seems more moody than expected include alcohol and drug use, sleep deprivation, and being a victim of bullying including psychological, physical and sexual abuse. Although parents need to be vigilant for all these possibilities, be reassured that regular periods of moody and irritable behaviour is par for the course in the teen years. Being supportive and accessible without being intrusive (not as easy as it sounds!), is usually all that is required. If in doubt, seek the advice of your family physician, pediatrician or local mental health professional.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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