Symptom Comparison:
ADHD, Bipolar Disorder, Reactive Attachment Disorder

Symptom

ADHD

Bipolar I Disorder

RAD

Age of onset

Birth, 6, 13

2-3, 7, 13-35

Birth to 3

Family history

ADHD, academic difficulties, alcohol & substance abuse

Mood disorders, academic difficulties, alcohol & substance abuse, adoption, ADHD

Abuse & neglect, severe emotional & behavioral disorders, alcohol & substance abuse, abuse & neglect in parent's own early life

Incidence

Approx. 6% of general population

2-3% of general population

3-6% of general population

Cause

Genetic, exacerbated by stress

Genetic, exacerbated by stress & hormones

Psychological secondary to neglect, abuse, abandonment

Duration

Chronic & unremittingly continuous, tends toward improvement

May or may not show clear behavioral episodes & cyclicity; worsens over years with increased severe and dramatic symptoms

Dependent on life circumstances, including treatment & innate temperament; worsens over years without treatment, resulting in antisocial character disorders

Attention span

Short, leading to lack of productivity

Dependent on interest & motivation, distractible

Usually prolonged secondary to hypervigilance, under stress can shorten

Impulsivity

Secondary to inattention or oblivious, regret

Driven, "irresistible," grandiosity, thrill-seeking, counter-phobia, little regret

Usually deliberate actions; poor cause-and-effect thinking; no remorse

Hyperactivity

50% are hyperactive, disorganized

Wide ranges, with hyperactivity common in children

Common

Self-esteem

Low, rooted in ongoing performance difficulties

Low because of inherent unpredictability of mood

Low, rooted in abandonment, feel worthless & unlovable, masked by anger

Attitude

Friendly in a genuine manner

Highly unpredictable, dysphoric, moody, negativistic

Superficially charming, phony, distrusting, emotionally distant, nonintimate

Control issues

Tend to desire to seek approval; get into trouble by inability to complete tasks

Intermittent desire to please (based on mood), tend to push limits and relish power struggles

Controlled and controlling, only for self-gain, underhanded, covert & punitive

Oppositional/defiant

Argumentative, but will relent with some show of authority, redirectable

Usually overtly & prominently defiant, often not relenting to authority

Covertly or overtly defiant, passive aggressive

Blaming

Self-protective mechanism to avoid adverse consequences

Enjoys "getting away with it"

"Crazy lying," self-centered "primary process" distortions, remain in control

Fire setting

Play with matches out of curiosity, nonmalicious

Play with matches/fire setting

Revenge motivated, malicious; danger seeking secondary to despair

Anger, irritability, temper, rage

Situational, in response to over stimulation, low frustration tolerance & need for immediate gratification; rage reaction is usually short lived

Secondary to limit setting or attempts by authority figures to control their excessive behavior, can last for extended periods of time; overt, assaultive

Chronic, revenge oriented; eternal "victim" position, with rationalizations for destructive retaliation; hurtful to innocent others and pets

Entitlement

Overwhelming need for immediate gratification

Feel entitled to get what they want, grandiose

Compensation for abandonment & deprivation

Conscience development

Capable of demonstrating remorse when calmed down

Limited conscience development, less cruel than RAD

Very "street smart," good survival skills, con artists, calculating, lack of remorse

Sensitivity

Oblivious to their circumstances, inappropriateness shows as result

Acutely aware of circumstances and are "hot reactors"

Hypervigilant, compensating for past helplessness; limited emotional repertoire, insensitive

Perception

Flooded by sensory overestimation, hyperactive, distractible, shuts down

Self-absorbed, preoccupied with internal need fulfillment, narcissistic

Self-centered, primary process, primitive distortions

Peer relationships

Makes friends easily, but not able to keep them

Can be charismatic or depressed, depending on mood, conflicts are the rule

Very poor, controlling & manipulative; not able to maintain relationships

Sleep disturbances

Overstimulated, once asleep "sleeps like a rock"

Inability to relax because of racing mind; nightmares common

Hypervigilance creates light sleepers; tends to need little sleep, arise early in am

Motivation

Less resourceful, more adult dependent; OK starters, poor finishers

Grandiose; believe they are resourceful, gifted, creative, self-directed, variable energy & enthusiasm

Consistently poor initiative, limited industriousness, intentional inefficiency

Learning difficulties

Commonly have auditory perceptual difficulties, lack fine motor coordination

Nonsequential, nonlinear learners, verbally articulate

Brain maturational delays secondary to maternal drug/alcohol effects, early life abuse/neglect can create diverse learning problems

Anxiety

Uncommon, unless performance related

Emotionally wired & have high potentials for anxiety, fears & phobias. Somatic symptoms common, needle phobic

Appear invulnerable; poor recognition, awareness or admission of fears

Sexuality

Emotionally immature & sexually naive

Sexual hyperawareness, pseudomaturity, and high activity level

Uses sex as means of power, control, or of infliction of pain, sadistic

Substance abuse

Strong tendencies, more out of coping mechanisms for low self-esteem

Strong tendencies in attempt to medically treat either hypomanic/depressive moods

Sporadic/uncommon, need to maintain control

Optimal environment

Low stimulation & stress, support & structure

Clear & assertive, limits, encouragement

Balance of security & stability, limits and clear expectations, nurturance and encouragement

Psychopharmacology

Medications very helpful: Ritalin, Dexedrine, Cylert, Wellbutrin; Clonidine, Imipramine & Nortirptyline useful as adjunctive treatments

Medications helpful to stabilize mood: Lithium, Carbamazepine, Valproic Acid, Verapamil, Risperdal

Antidepressants, Clonidine, may help decrease hypervigilance, does not help characterological traits

Attachment, Trauma, & Healing; Understanding and Treating Attachment Disorder in Children and Families, Terry M. Levy & Michael Orlans