Pediatric Bipolar d/o or what...?

How to distinguish pediatric bipolar d/o from various other d/o's

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Picture this….: A new adolescent male presents to your office. He is 14 years old. The accompanying parent states, “I swear he is bipolar!” Throughout the assessment it is determined that the patient has difficulty with authority figures, particularly his mom & female teachers. He is somewhat irritable and can lose his temper easily. He breaks rules frequently, but does not engage in violent or destructive behavior. You find that the behaviors aren’t really episodic in nature, but rather appear when the patient is asked or expected to do things that he does not want to do.

Does this patient’s symptoms line up with Bipolar d/o..? Possibly, let’s consider a few other factors… With further digging, it is determined that the patient sleeps well at night & has never gone periods of time with less sleep without feeling fatigued. He has also never engaged in sexually inappropriate behavior. Ok… So although the patient may have some behaviors which could be shared by an adolescent with bipolar d/o. This patient’s presentation is more congruent with a diagnoses of Oppositional defiant d/o.

Why ODD & not CD? Because although the patient does engage in rule breaking and