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To the child in rage, it is a life and death struggle.As the limbic system flares on, adrenaline spikes, the child becomes stronger, and the thinking brain located in the frontal cortex shuts down.Depression is a state of extreme sadness, lethargy, and physical debilitation.It is as much a physical syndrome as a mental condition.Sudden, explosive rage: The rage that occurs in bipolar disorder is different from anger.It happens at the drop of a hat with no provocation, and as Hagop Akiskal, MD, psychiatry professor and director of the International Mood Center at San Diego Veterans Administration Medical Center, and specialist on bipolar disorder in children, says, it is “sudden and explosive.” A raging child may attack others with weapons, may scream, cry, and laugh at the same time. The nerve centers responsible for rage are located in the limbic system or “animal brain” that contains structures essential to our survival through the “fight or flight” response.When the following challenges are present in a child’s life, I make the diagnosis of attention deficit disorder with or without hyperactivity.The features listed here are tested on the Brown Scales, a popular clinical instrument for diagnosing attention disorders in children.
Unable to focus on anything in a satisfactory way, they are driven to move about in search of rewarding stimulation. Children with attention deficit disorders and without hyperactivity often say that they experience an internal hyperactive sense: “calm on the outside, a cyclone on the inside.” Children with these issues may be delightful to be with because of their spontaneity, creativity, and high energy.Manic children believe that they can accomplish things magically.They may express this fantasy by jumping out of a moving car, climbing on the roof of a house and dancing, or thinking that they are powerful enough to throw a ball over a skyscraper.The National Institute of Mental Health (NIMH) has identified the following characteristics of early onset bipolar disorder: depression, irritability, rage, poor frustration tolerance, mania, and psychosis and suicidal tendencies.All of these features are listed for bipolar disorder in adults in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, except rage, psychosis, and poor frustration tolerance.