Attention deficit hyperactivity disorder and bipolar disorder have some similar symptoms. But there is no one formal test for either. A diagnosis is often based on what is observed. These tests can work well. Still, doctors and parents want stronger evidence, and the key may be unlocking secrets of what goes on inside the brain.
For 11-year-old Vajaran Nall, when it comes to video games, there's no daydreaming But, it's a different situation at school, where his mom says he's distracted and his grades are slipping. Doctors suspect an attention disorder.
"She was thinking it might be some form of ADHD," said Vajaran's mother Rosie Wright, "but she wouldn't swear by it. More testing needed to be done."
The outward signs are there, but Wright wants to know what's really going on in her son's head.
Researchers at the University of Illinois at Chicago have the same questions. They are hoping to find answers by unlocking the secrets of the thinking and feeling parts of the brain with specialized scans called functional MRIs.
"This is a great way to look into the window of what is plastic and growing and developing in young children," said Dr. Mani Pavuluri, UIC child psychiatrist.
These non-invasive scans map out what parts of the brain are turned on or off in a patient.
In the test Nall holds a video-game-like controller. Images of faces flash on a screen. His job is to indicate what he sees. Meanwhile the scanner keeps track of what's happening in the part of the brain that regulates emotion.
"We actually gain a lot of important information on how the dysfunction of the brain really happens in terms of how they really see the world, how they process information and how they react to what they see," said Alessandra Passarotti, Ph.D., UIC cognitive neuroscientist.
UIC researchers are using brain imaging to help identify which children have ADHD and which have bipolar disorder. Both disorders share similar characteristics
Getting the diagnoses right can be tricky. A misdiagnosis can lead to the wrong treatments.
With the scans, UIC researchers are discovering that ADHD and bipolar children both have dysfunction in the prefrontal cortex. That's the part of the brain that controls behavior, working memory, attention and language.
Children with ADHD had more dysfunction in working memory circuits, while the bipolar group had more deficits in the regions of the brain involved in emotion processing and regulation.
"When we look at the brain we are really starting to understand how they differ," said Dr. Pavuluri, "and this is important, because once we have that knowledge we can really think about better diagnosis and better intervention."
For example, this helps explain why children with bipolar disorder may not do so well with reward-and-punishment-based discipline. Study participant Luke Mallard is a good example.
"I actually enjoy it because it feels cool," Luke said.
Cindy Mallard says helping her bright son navigate his bipolar disorder has involved a lot of trial and error. She's hoping the UIC research will help.
"It's going to be neat to see how his brain changes over the next four years," Cindy said.
These scans are not being used to diagnose patients. The hope is that by studying many children a model can be formed to help with future diagnosis and treatments.
Both disorders are complex and studying just one region of the brain will not answer everything.
UIC researchers are still looking for study participants. Visit UIC's Pediatric Brain Research and Intervention Center website at www.psych.uic.edu/brain-center or phone (312) 413-1710.
National Institute of Mental Health