The Confusion Between Autistic Spectrum Disorders and Bipolar Disorder

Autistic Spectrum Disorders (also known as Pervasive Developmental Disorders, or PDDs in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders)) are characterized by severe and pervasive impairment in several areas of a child's development. These may include difficulties with social interaction and communication skills as well as repetitive behaviors (hand flapping when excited is a common example in some ASD kids), activities such as having to take the same route to school every day, and special interests (talking about trains, trains, and more trains, to the exclusion of other topics). The disorders under this diagnostic umbrella include Autism, Asperger's Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD NOS)

• Autism is a disorder in which a child is markedly impaired in his verbal and nonverbal communication skills and in his ability to interact socially in a give-and-take manner with others. Children with ASDs also exhibit some particular behaviors, such as rocking when excited or bored.
• Asperger's Syndrome is characterized by social impairment and restricted and repetitive behavior patterns but not by significant delays in a child's language, cognitive development, age-appropriate self-help skills, or adaptive behavior.
• Pervasive Developmental Disorder Not Otherwise Specified is the diagnosis that refers to children who do not meet the full criteria for Autism or Asperger's Syndrome or certain other very specific disorders but do show some symptoms of an ASD.

Kids with ASD are typically rigid and preoccupied with sameness in their day-to-day living. They can be inflexible when it comes to following specific routines or rituals, such as lining up toy cars in a row or wearing their coats everyday regardless of the temperature outside. Research by the U.S. Department of Education and other governmental agencies indicates that ASDs are the fastest-growing developmental disabilities among children and affect 2 to 6 out of every 1,000 individuals, or 1 in 166 births.¹ The number of youngsters who have both Bipolar Disorder and an ASD is unknown, but I have seen quite a few kids with this combination. At times, the overlap of symptoms and the diagnostic confusion surrounding the two disorders can be quite challenging.

The areas of similarity between an ASD and Bipolar Disorder are further outlined in the list that follows. Children in both groups may have these symptoms:

• Onset of the disorder prior to age three:Children in both groups may appear overactive, impulsive, inattentive, and aggressive, and they may begin throwing temper tantrums when very young.
• Sensory hypersensitivity: They may have tactile, gustatory(taste), olfactory (smell), auditory, or visual hypersensitivity that includes intolerance for everything from tags in clothes to loud noises in a concert hall and smells at the zoo. In bipolar kids, this trait is more prominent during the depressive phase.
• A tendency to become absorbed in certain topics and be somewhat preoccupied by them: These kids may learn everything about a subject, such as Star Wars or the Beatles, and want everything related to it. This is different than the typical preoccupations in kids without psychiatric disorders. The fascination of bipolar kids and/or youngsters with an ASD takes on more of an obsessive-compulsive quality. These children might talk on and on about their favorite topics without regard to how people around them are reacting. The difference is that the bipolar child whose mood is stable can move on to other subjects. A child with an ASD is very rigid in his interest—to the exclusion of most other possible interests in life. When the bipolar child is depressed, he may show an increase in the intensity of his preoccupations, which at that point can seem similar to the behavior of a child with an ASD.
• A difficult time transitioning from one activity to another: Kids in either group can have major temper tantrums around this issue. Again, this is often much more apparent in bipolar children when they are depressed.

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