Not that any of us confused parents need another addition to the alphabet soup of potential diagnoses for our “combo platter” kids…but, the National Institute of Mental Health (NIMH) released a most interesting report last week of a study that may be the start of distinguishing pediatric Bipolar Disorder (BD) from another, similar disorder – Severe Mood Dysregulation (SMD).

Researchers at NIMH compared the EEGs of children with BD and those believed to have SMD, and found that they have surprisingly different electrical patterns. This leads researchers to believe that these two disorders may need to be treated very differently.

If you’re like me, SMD is a new one. I searched and found little information out there, except that is was only recently defined and is often treated like BD. This caught my attention, because five years ago LuLu had her first QEEG. I took it, along with another done the following year, to our psychiatrist when we finally acquiesced and began to explore medication options. Our psychiatrist very clearly told me that LuLu had a severely dysregulated electrical pattern, BUT, that she did not have Bipolar Disorder. However, much of her medication regime is similar to that of people with BD.

So what is SMD? It shares many of the same symptoms as BD, except the clear-cut manic episodes are not there. Irritability, hyperactivity, low tolerance of frustration are hallmark symptoms of SMD. Inability to sleep is another symptom. It’s that "frustration provoked by goal-oriented tasks" that has my attention. Rages and temper tantrums in more than one setting (i.e. home and school) was also mentioned. Hmmm…

The interesting thing is that researchers believe that SMD occurs at a higher rate in children than BD. They estimate that 3% of the population has SMD. Violent outbursts (both physical and verbal) are common, as are chronic negative moods and rages. The hereditary factors of BD don't seem to be there in SMD. I found another research paper saying that the vast majority of children with SMD have been diagnosed as the ADHD/ODD. Hmmm…

The NIMH study involved children doing a task in which they lost money if they were unable to do it – increasing their frustration. The EEGs found that different parts of the brain were activated during the frustration in children with BD vs. SMD. This may lead to different treatments and medications being used for each disorder.

I gotta tell you that I’m easily frustrated (probably you are too) that no professional has a handle on what our “combo platter” children truly have -- or what to do about it. As a mom, I want answers and I want them NOW!

But, I’m encouraged by studies such as this one. Here’s why:

The new study shows that clinicians some day could use biological measurements, such as EEGs, to help make psychiatric diagnoses, in combination with clinical symptoms. Currently, clinicians diagnose
mental illnesses based on symptoms alone. The difficulty of diagnosing BD in children is compounded by the frequent co-occurrence of one or more other mental disorders.

"We're approaching the day when we'll be able to use neuroscience techniques to improve psychiatric diagnoses. Pediatric BD has some of the most pressing needs in this regard, because of its severity and
because of questions about how to best make the diagnosis," said senior author Ellen Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and
Anxiety Disorders Research Program.

This confirms my theory that someday all psychiatric disorders will have an identifiable neurological “pattern” that can be seen on EEGs or other type of brain mapping tools. And that neurologists and psychiatrists will figure out how to intervene biochemically or neurodevelopmentally to help change these patterns.

But the science isn’t there yet. So, parents of “combo platter” kids do the best we can. I talk to parents all the time who are trying to figure out if their child has BD or not. They have all the diagnoses – ADHD, ODD, CD, BD, and in our adoptive/foster world PTSD/RAD. Their doctors are trying to figure out if they have BD or not. I bristle when people (professionals or parents) make absolute statements – ones like all our kids really have BD because RAD doesn’t exist or ADHD isn’t real or certain diagnoses can’t co-exist with others. The truth is that NOBODY KNOWS – not definitively. Diagnosis of mental illnesses are based on symptoms. Sadly, observation of symptoms and trial and error of treatments is really are the only way – for now….


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