Things currently bundled with ADHD that might fit better with mania:
If ADHD is an impulse problem and characterized by poor task persistence, then there are common traits in ADHD children that are inconsistent with ADHD. These traits make more sense if a mania label is included.
1) Laboratory measures of ADHD, such as a continuous performance test (CPT) are presently discounted because 35% of children who are rated as "ADHD" by their teachers can do well on a CPT. Current practice is to give accept the teacher and parent ratings and discount the CPT. Because active, talkative, distractible children could have either ADHD or mania or both, a more reasonable approach might be to examine the CPT "passers" with greater suspicion. Family history of mania and a more detailed consideration of teacher and parental comments may reveal children who are inattentive only for things that are irrelevant to social power. Children passing the CPT have been reported to be more socially disruptive (Fischer, et al., 1995) than those who do not. The CPT could be an early way to sort children for ADHD or mania before rating forms are taken, scored, and interpreted. Some children respond on the Connors CPT (1994) with high rate and high accuracy responses that waver little during the 14 minutes of the test. Or, they make up strategies such as "say the letter first" and stick to it for the entire test. These children are intensely annoying, bossy, and committed to their own goals, whether in school or home. Other children are erratic on the CPT despite attempting to "say the letter first." These latter children don't stick to their plan, abandoning it after a couple of errors.
2) A certain percentage of ADHD children exhibit "rapid cycling" when treated with a tricyclic or with a serotonin reuptake inhibitor (Spencer, 1996). Their moods go up and down, to extreme degrees, every couple of days or weeks or even within a single day. Are these the same children who also pass CPT scrutiny? Are these children also driven to attain dominance rather than distraction? Were these children unusually persistent or domineering before the medication? Is there a family history of mania or bipolar disorder?
3) Some children diagnosed with ADHD may be primarily manic and given their diagnosis because of high activity and irritating their teachers or parents. Behavior for either diagnosis can be annoying behavior, the one by a lack of task persistence and the other by an excess. If manic children are driven for power, then conflicts with teachers and other authorities should be more likely and probably more distressing than the disruptions caused by an ADHD child. A manic child can take things "very personally" and intend their retaliation to be just as hurtful to their target.
4) Mania and ADHD are thought to have some genetic foundations. Family histories of highly determined, restless children should have a higher incidence of adults and siblings who are also persistent about winning. Temper problems, high activity level, heightened sexuality, lying, and social manipulation ought to be more frequent. Higher frequencies of extreme beliefs, long-standing feuds, excessive spending patterns, or legal difficulties might also be expected. (See my comments about Linkage Disequilibrium in the notes to Dandelion Tears; there is some evidence that manics, or people with mania in their families, are attracted to each other as marital partners.)
5) A distinction has been made (e.g., Biederman, et al., 1996) between early and late onset ADHD. The late onset group is more likely to show remission, perhaps during the late teen years. Is this a manic group? A certain percentage of children are said to "grow out" of ADHD. Some of that percentage may be due to our clumsy initial assessments and relatively few children grow out of it. Some of them may also have been going through a manic phase (elicited by school pressure or irrelevance or dominance motives that are met in adulthood once the person is less monitored and restricted in his activity?).
6) Medications might be more consistent with diagnosis. There are already suggestions for using depakote or carbamazepine for control of aggression, tantrums, and property destruction (Baran, 1996; Nadeau, 1996) Such behaviors are not likely to be mere dust devils of the child's mind but are likely to have cognitive and environmental antecedents in the area of dominance (and, later, mating). These are mania kinds of medications (although the mechanisms are unknown) and being given for severe mania kinds of behavior in ADHD children.
Cont. in part 2.5