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William Allan Kritsonis, PhD

Dr. Kritsonis Lectures at the University of Oxford, Oxford, England

In 2005, Dr. Kritsonis was an Invited Visiting Lecturer at the Oxford Round Table at Oriel College in the University of Oxford, Oxford, England. His lecture was entitled the Ways of Knowing Through the Realms of Meaning.

Dr. Kritsonis Recognized as Distinguished Alumnus

In 2004, Dr. William Allan Kritsonis was recognized as the Central Washington University Alumni Association Distinguished Alumnus for the College of Education and Professional Studies. Dr. Kritsonis was nominated by alumni, former students, friends, faculty, and staff. Final selection was made by the Alumni Association Board of Directors. Recipients are CWU graduates of 20 years or more and are recognized for achievement in their professional field and have made a positive contribution to society. For the second consecutive year, U.S. News and World Report placed Central Washington University among the top elite public institutions in the west. CWU was 12th on the list in the 2006 On-Line Education of “America’s Best Colleges.”


Educational Background

Dr. William Allan Kritsonis earned his BA in 1969 from Central Washington University, Ellensburg, Washington. In 1971, he earned his M.Ed. from Seattle Pacific University. In 1976, he earned his PhD from the University of Iowa. In 1981, he was a Visiting Scholar at Teachers College, Columbia University, New York, and in 1987 was a Visiting Scholar at Stanford University, Palo Alto, California.

Professional Experience

Dr. Kritsonis began his career as a teacher. He has served education as a principal, superintendent of schools, director of student teaching and field experiences, invited guest professor, author, consultant, editor-in-chief, and publisher. Dr. Kritsonis has earned tenure as a professor at the highest academic rank at two major universities.

Books – Articles – Lectures - Workshops

Dr. Kritsonis lectures and conducts seminars and workshops on a variety of topics. He is author of more than 500 articles in professional journals and several books. His popular book SCHOOL DISCIPLINE: The Art of Survival is scheduled for its fourth edition. He is the author of the textbook William Kritsonis, PhD on Schooling that is used by many professors at colleges and universities throughout the nation and abroad.
In 2007, Dr. Kritsonis’ version of the book of Ways of Knowing Through the Realms of Meaning (858 pages) was published in the United States of America in cooperation with partial financial support of Visiting Lecturers, Oxford Round Table (2005). The book is the product of a collaborative twenty-four year effort started in 1978 with the late Dr. Philip H. Phenix. Dr. Kritsonis was in continuous communication with Dr. Phenix until his death in 2002.
In 2007, Dr. Kritsonis was the lead author of the textbook Practical Applications of Educational Research and Basic Statistics. The text provides practical content knowledge in research for graduate students at the doctoral and master’s levels.
In 2008, Dr. Kritsonis’ book Non-Renewal of Public School Personnel Contracts: Selected Supreme and District Court Decisions in Accordance with the Due Process of Law is scheduled for publication by The Edwin Mellen Press, Lewiston, New York.
Dr. Kritsonis’ seminar and workshop on Writing for Professional Publication has been very popular with both professors and practitioners. Persons in attendance generate an article to be published in a refereed journal at the national or international levels.
Dr. Kritsonis has traveled and lectured throughout the United States and world-wide. Some recent international tours include Australia, New Zealand, Tasmania, Turkey, Italy, Greece, Monte Carlo, England, Holland, Denmark, Sweden, Finland, Russia, Estonia, Poland, Germany, and many more.


Founder of National FORUM Journals – Over 4,000 Professors Published

Dr. Kritsonis is founder of NATIONAL FORUM JOURNALS (since 1983). These publications represent a group of highly respected scholarly academic periodicals. Over 4,000 writers have been published in these refereed, peer-reviewed periodicals. In 1983, he founded the National FORUM of Educational Administration and Supervision – now acclaimed by many as the United States’ leading recognized scholarly academic refereed journal in educational administration, leadership, and supervision.
In 1987, Dr. Kritsonis founded the National FORUM of Applied Educational Research Journal whose aim is to conjoin the efforts of applied educational researchers world-wide with those of practitioners in education. He founded the National FORUM of Teacher Education Journal, National FORUM of Special Education Journal, National FORUM of Multicultural Issues Journal, International Journal of Scholarly Academic Intellectual Diversity, International Journal of Management, Business, and Administration, and the DOCTORAL FORUM – National Journal for Publishing and Mentoring Doctoral Student Research. The DOCTORAL FORUM is the only refereed journal in America committed to publishing doctoral students while they are enrolled in course work in their doctoral programs. In 1997, he established the Online Journal Division of National FORUM Journals that publishes academic scholarly refereed articles daily on the website: www.nationalforum.com. Over 500 professors have published online. In January 2007, Dr. Kritsonis established Focus: On Colleges, Universities, and Schools.

Professorial Roles

Dr. Kritsonis has served in professorial roles at Central Washington University, Washington; Salisbury State University, Maryland; Northwestern State University, Louisiana; McNeese State University, Louisiana; and Louisiana State University, Baton Rouge in the Department of Administrative and Foundational Services.
In 2006, Dr. Kritsonis published two articles in the Two-Volume Set of the Encyclopedia of Educational Leadership and Administration published by SAGE Publications, Thousand Oaks, California. He is a National Reviewer for the Journal of Research on Leadership, University Council for Educational Administration (UCEA).
In 2007, Dr. Kritsonis has been invited to write a history and philosophy of education for the ABC-CLIO Encyclopedia of World History.
Currently, Dr. Kritsonis is Professor of Educational Leadership at Prairie View A&M University – Member of the Texas A&M University System. He teaches in the newly established PhD Program in Educational Leadership. Dr. Kritsonis taught the Inaugural class session in the doctoral program at the start of the fall 2004 academic year. In October 2006, Dr. Kritsonis chaired the first doctoral student to earn a PhD in Educational Leadership at Prairie View A&M University. He lives in Houston, Texas.

Posted by William Allan Kritsonis, PhD at July 4, 2008 12:55 AM

Dr. William Allan Kritsonis Helps Doctoral Students and Faculty Members Publish

Washington Post – Press Release

In 2007 and 2008, Dr. William Allan Kritsonis, a professor teaching in the PhD Program in Educational Leadership at PVAMU/Member of the Texas A&M University System mentored doctoral students to publish over 125 national refereed, peer-reviewed articles in professional journals; he helped faculty members publish over 98 articles.
During this time, Dr. Kritsonis had a book published by members of the Oxford Round Table in the University of Oxford, Oxford, England. He was also invited to write a history and philosophy of education for the ABC-CIO Encyclopedia of World History.
Dr. Kritsonis published two articles in the Encyclopedia of Educational Leadership and Administration published by SAGE Publications, Thousand Oaks, California.
In summary, Dr. Kritsonis helped doctoral and faculty members in the PhD Program in Educational Leadership at PV publish over 200 national refereed articles in professional periodicals. Over 80 of these articles are indexed in the national data base system ERIC (Education Resources Information Center).

Posted by William Allan Kritsonis, PhD at July 4, 2008 12:57 AM

Writing for Professional Publication in National Refereed Journals
A Session for Faculty and Doctoral Students

University of Washington
College of Education
Seattle, Washington

William Allan Kritsonis, PhD
Professor
PhD Program in Educational Leadership
Prairie View A&M University/The Texas A&M University System

1. Professional reasons for writing for publication
2. Personal reasons for writing for publication
3. How real writers behave
4. Writer’s write for the following reasons
5. How to get started
6. What will “sell” the editor on your work?
7. Formula: Brilliant Ideas + Good Luck + Knowing the Right People = Publication
8. On scholarly work
9. Reasons to write and publish journal articles
10. Writing and publishing journal articles enables you to…
11. Three basic types of articles: practical – review or theoretical – research
12. Quantitative Studies
13. Qualitative Research
14. On writing books
15. Four phases of book publishing (Fun – Drudgery – Torture – Waiting)
16. Some reasons to write a book
17. Where does the dollar go after a book is published?
18. What do editors and reviewers really want?
19. Earning approval from editors and reviewers
20. What to remember about bad writing
21. How to get fired as a reviewer
22. Publish or perish or teach or impeach
23. I’ve been rejected many times – should I give up?
24. In writing, how you read is important
25. How teachable is writing?
26. “I can’t seem to tell how my writing is going while I am doing it. Can you help?
27. Remember your purpose in writing
28. What differentiates ordinary writing from writing with style
29. It must get somewhat easier to write, otherwise, how would some authors become so prolific?
30. If writing for publication does not prove to be lucrative, why bother?
31. Why creative work is worthwhile
32. Show respect for your writing. It is about what the readers should know. If this puts a strain on a professional relationship, then so be it.
33. “Why I Write” (Orwell) Sheer egoism, aesthetic enthusiasm, historical impulse, and political purpose.
34. What really makes an academic write?
35. The Writer’s Essential Tools – words and the power to face unpleasant facts.
36. No human activity can sap the strength from body and life from spirit as much as writing in which one doesn’t believe.
37. “Because it was there.” Edmund Hillary. And with this comment he supplied generations with a ready-made and unanswerable defense for any new undertaking even writing.
38. Why we write.
39. Climbing Your Own Mountain
40. Be yourself. Have fun writing.

Please list any other topics you want Dr. Kritsonis to discuss.
281-550-5700 Home; Cell: 832-483-7889 – williamkritsonis@yahoo.com

Posted by William Allan Kritsonis, PhD at July 4, 2008 12:58 AM

William Allan Kritsonis

Selected National/International Refereed, Blind-Reviewed, Peer-Evaluated Journal Articles

2008

Reprinted with permission: "Educational Leaders as Stewards: Selecting A National Curriculum Guided by the Ways of Knowing Through the Realms of Meaning" Journal of the Massachusetts chapter of ASCD, Harvard University Chapter, Cambridge, Massachusetts. Upcoming issue to accentuate the importance of developing a whole child curriculum. Summer 2008.

Hines, III, M.T., & Kritsonis (2008) An In-Depth Analysis of the Cognitive and Metacognitive Dimensions of African American Elementary Students’ Mathematical Problem Solving Skills. Focus On Colleges, Universities, and Schools, 2 (1)

Morgan, M., & Kritsonis, W.A. (2008) Beyond the First Days of School: The Recruitment,
Retention, and Development of Quality Teachers in Hard-to-Staff Schools: A National Focus.
National FORUM of Educational Administration and Supervision Journal, 25 (3)

Kritsonis, W.A., & Marshall, R.L.(2008) Doctoral Dissertation Advising: Keyes to Improvement of Completion Rates. National FORUM of Educational Administration and Supervision Journal, 25 (3)

Laub, J.D., DeSpain, B.C., & Kritsonis, W.A. (2008) An Analysis of the Rural Public School
Superintendency. National FORUM of Educational Administration and Supervision
Journal, 25 (2)

Torrez, A., & Kritsonis, W.A. (2008) Smaller Learning Communities: Pre-Implementation Planning Critical to Success. National FORUM of Applied Educational Research Journal, 21 (2)

Ivy, Adam, I., Herrington, D.E., & Kritsonis, W.A.(2008). The Challenge of Building Professional Learning Communities: Getting Started. National FORUM of Applied Education Research Journal, 21 (2)

McLeod, K., Tanner, T., & Kritsonis,W.A. (2008). National Impact: Model of a Culturally Active Classroom. National FORUM of Applied Educational Research Journal, 21 (2)

Kritsonis, W.A. (2008) Functions of the Dissertation Advisor. National Journal: Focus On Colleges, Universities, and Schools, 2 (1)

Hines, III, M., & Kritsonis, W.A.(2008). National Implications: Racial Differences in In-service Teachers’ Perceptions’ of Caucasian American Culturally Proficient School Leadership.
National FORUM of Educational Administration and Supervision Journal, 25 (4)


Morgan, M. M., & Kritsonis, W.A. (2008). The Real Philadelphia Experiment: How Benjamin
Franklin’s 13 Virtues can Save a School from Itself. National FORUM of Teacher Education Journal, 18 (3)

Herrington, D.E., Kritsonis, W.A., & Tanner, T. (2008). National Recommendations for Deconstructing Educational Leadership Courses: Re-Centering to Address the Needs of Students. National FORUM of Educational Administration and Supervision Journal, 25

Butcher, J., & Kritsonis, W.A. (2008) A National Perspective: Utilizing the Postmodern Theoretical Paradigm to Close the Achievement Gap and Increase Student Success in Public Education America. National FORUM of Educational Administration and Supervision Journal, 25 (4)
(ERIC Document Reproduction Service No ED499482)

Egbe, R., Ivy, A., Moreland, B., Willis, L., Herrington, D.E., & Kritsonis, W.A. (2008). Ten Things to Consider When Developing a Survey or Assessment Instrument. National FORUM of Applied Educational Research Journal, 21 (3)

Glasco, R.L., Herrington, D.E., & Kritsonis, W.A. (2008). Developing and Nuturing a Common Vision for Technology Integration in Education. National FORUM of Applied Educational Research Journal, 21 (3)

Herrington, D.E., & Kritsonis, W.A. (2008). Essential Reflections for Non-Profits and School Prior to Writing and Submitting Grant Proposals. National FORUM of Applied Educational Research Journal, 21 (3)

Cloud, M., & Kritsonis, W.A. (2008). National Implications: Implementing Postmodernistic Strategies and the Ways of Knowing Through the Realms of Meaning for the Improvement of Ethical Conduct for the Improvement of Public Education. National FORUM of Applied Educational Research Journal, 21 (3) (ERIC Documentation Reproduction Service No.ED499279)

Watkins, D., & Kritsonis, W.A. (2008). Aristotle, Philosophy, and the Ways of Knowing Through the Realms of Meaning: A National Study on Integrating a Postmodernist Approach to Education and Student Academic Achievement. National FORUM of Applied Educational Research Journal, 21 (3)
(ERIC Documentation Reproduction Service No.ED499545)

Butcher, J., & Kritsonis, W.A. (2008). Implementing the Ways of Knowing Through the Realms of Meaning to Assist Leaders in Retaining Alternatively Certified Teachers: Six National Recommendations for Improving Education in the United States of America. National FORUM of Applied Educational Research Journal, 21 (3)
(ERIC Document Reproduction Service No ED499483)

Bowman, E., Herrington, D.E., & Kritsonis, W.A. (2008). Seven Ways to Increase At-Risk Student Participation in Extra-Curricular Activities. National FORUM of Teacher Education Journal, 18 (3)

Puentes, H., Herrington, D.E., & Kritsonis, W.A. (2008). A Case Study with National Implications: Student Mobility and Academic Achievement at a Selected Elementary School Campus. National FORUM of Teacher Education Journal, 18 (3)

Jedlicka,K., Herrington, D.E., & Kritsonis, W.A. (2008). The Persistence of Teacher Under-Utilization of Computer Technologies in the Classroom. National FORUM of Teacher Education Journal, 18 (3)

Cloud, M., & Kritsonis, W.A. (2008). National Agenda: Implementing the Ways of Knowing Through the Realms of Meaning for the Improvement of Public Education. National FORUM of Teacher Education Journal, 18 (3)

Smith, M.M., Herrington, D.E., Kritsonis, W.A., & Tanner, T. (2008). National Implications: Ten Things to Consider When Teaching Mathematics to African American Students. National FORUM of Multicultural Issues Journal, 5 (1)

McLeod, K., Tanner, T., & Kritsonis, W.A. (2008). National Recommendations for Improving Cultural Diversity: Model of a Culturally Active Classroom Setting. National FORUM of Multicultural Issues Journal, 5 (1)

Joshua, M.T., Joshua, A.M., Obi, F.B., Umoinyang, I.E., Ntukidem, E.P., Kritsonis, W.A., Tanner, T., & DeMoulin, D.F. (2008). Conceptualization and Perceptions of Teaching as an Artistic Form: National and International Implications for Evaluation and Assessment. International Journal of Scholarly Academic Intellectual Diversity, 11 (1)

Joshua, A.M., Ukpong, E.M., Joshua, M.T., Kritsonis, W.A., Tanner, T., & DeMoulin, D.F. (2008). Distribution Patterns of the Four Fundamental Temperaments among Secondary School Students in Cross River State, Nigeria: National and International Implications. International Journal of Scholarly Academic Intellectual Diversity, 11 (1)

Joshua, M.T., Bassey, S.W., Asim, A.E., Kritsonis, W.A., Tanner, T. & DeMoulin, D.F. (2008). National and International Implications for Universal Basic Education: Primary School Teachers’ Perceived and Conceived Continuous Assessment Difficulties and Reporting Competence in Cross River South, Nigeria. International Journal of Scholarly Academic Intellectual Diversity, 11 (1)

Kritsonis, W. A. (2008). Functions of the Dissertation Advisor. National Journal: FOCUS On Colleges, Universities, and Schools, 2 (1)

Watkins, D., & Kritsonis, W.A. (2008). National Promise for Student Academic Achievement and Success: Connecting Learning Utilizing the Ways of Knowing Through the Realms of Meaning. National Journal: FOCUS On Colleges, Universities, and Schools, 2 (1)

Taylor, J.H., & Kritsonis, W.A. (2008) National Implications: Quality of Effort and Selected Demographic Variables Contributing to the Prediction of Cognitive Outcomes. National Journal: FOCUS On Colleges, Universities, and Schools, 2 (1)

O’Brine,C.R., & Kritsonis, W.A. (2008). Segregation Through Brown vs. the Board of Education: A Setback or Landmark Case. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction No.ED499169)

Collins, C.J., & Kritsonis, W.A. (2008) National Agenda: Implementing Postmodern Strategies
To Guide Educational Leaders in Creating Schools for Quality Learning in Public Education
in America. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5(1)
(ERIC Document Reproduction No.ED499554)

Coates-McBride, A., & Kritsonis, W.A. (2008). The M&M Effect-Assessing the Impact of Merit Pay on Teacher Motivation: National Implications. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction No.ED499772)

Terry, L.A., & Kritsonis, W.A. (2008). A National Issue: Whether the Teacher Turnover Effects Students’ Academic Performance? DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.ED499543)

Walden, L., & Kritsonis, W.A. (2008). The Impact of the Correlation Between the No Child Left Behind Act’s High Stakes Testing and the Drop-Out Rates of Minority Students. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.ED499541)

Springs, M.A., & Kritsonis, W.A. (2008). National Implications: Practical Ways for Improving Student Self-Concept Through Student Achievement. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.ED499551)

Morgan, M., & Kritsonis, W.A. (2008). A National Focus: The Recruitment, Retention, and Development of Quality Teachers in Hard-to-Staff Schools. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.499323)

Charlton, D., & Kritsonis, W.A. (2008). The Documentation Process: The Administrator’s Role and the Interplay of Necessity, Support, and Collaboration. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.ED499101)

Henderson, F.T., & Kritsonis, W.A. (2008). Graduation Rates at Historically Black Colleges and Universities: A Review of the Literature. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)

Torrez, A., & Kritsonis, W.A. (2008). National Impact for Pre-Implementation of Smaller Learning Communities. DOCTORAL FORUM: National Journal for Publishing and Mentoring Doctoral Student Research, 5 (1)
(ERIC Document Reproduction Service No.ED499477)

Johnson, C., & Kritsonis, W.A. (2008) Impact of the Mathematics Curriculum on the Success of African American High School Students. National FORUM of Teacher Education Journal, 18(1& 2)

Smith, Y.E., & Kritsonis, W.A. (2008) Leaving Good Teachers Behind: A Professional Dilemma. National FORUM of Teacher Education Journal, 18(1& 2)

Norfleet, S., & Kritsonis, W.A. (2008) Educational Leadership for Improved School-Community Relations. National FORUM of Teacher Education Journal, 18(1& 2)

Watkins, D., & Kritsonis, W.A. (2008) Utilizing the Ways of Knowing Through The Realms of Meaning for a Postmodern Approach to Effecting Change in Special Education. National FORUM of Teacher Education Journal, 18(1& 2)

Townsell, R., & Kritsonis, W.A. (2008) Human Resource Management in Small Rural Districts: The Administrator’s Role in Recruitment, Hiring, and Staff Development. National FORUM of Teacher Education Journal, 18(1& 2
(ERIC Document Reproduction Service No.ED497694)

Love, A., & Kritsonis, W.A. (2008) A Principal’s Role in Retaining First Year Teachers. National FORUM of Teacher Education Journal, 18(1& 2)

Jacobs, K.D., & Kritsonis, W.A. (2008) Utilizing The William Allan Kritsonis Balanced Teeter-Totter Model as a Means to Cultivate a Legacy of Transformational Leaders in Schools.
National FORUM of Teacher Education Journal, 18(1& 2)

Posted by Anonymous at July 4, 2008 1:00 AM

BIOGRAPHY
Mary Alice Kritsonis, Ed.D.

Dr. Mary Alice Kritsonis earned her B.S. in Speech, Hearing, and Language Therapy in 1976 and her M.Ed. in Supervision in 1983 from Louisiana State University, Baton Rouge. Louisiana. In 1991, she earned her Ed.S. in Administration and Supervision from McNeese State University, Lake Charles, Louisiana. Dr. Kritsonis earned her Ed.D. in Special Education with emphasis in Early Childhood Special Education from Memphis State University, Memphis, Tennessee.
Her doctoral experiences included training at the Boling Center for Developmental Disabilities and the Evan R. Harwood Day Training Center. She also observed and received training at the Transitional Care Unit of Le Bonheur Children’s Medical Center and the Neonatal Intensive Care Unit of Women’s Hospital. Finally, Dr. Kritsonis worked with children, birth-2, who were developmentally delayed or medically diagnosed with established risk for delayed development in the Project Memphis and Mommies and Me programs.
Dr. Kritsonis began her career as a speech therapist. She has worked as a severe language disorder teacher, and a special education teacher working with students with mild/moderate disabilities in both the self-contained and resource settings. She has served as a member of a pupil appraisal team as a speech pathologist. Her school experiences range from the preschool to high school level. Dr. Kritsonis has also worked at the university level as a special education professor and a university supervisor of student teachers.
Dr. Kritsonis served as a professor in the Special Education Department at McNeese State University in Lake Charles, Louisiana. While at the university, she served as the On-Site Coordinator for the Non-Categorical Preschool/Early Intervention Personnel Recruitment and Enhancement Project. Dr. Kritsonis was also a University Mentor in the Special Education Mentorship Program. She was the only professor at the university appointed by the Governor of Louisiana to the Louisiana State Interagency Coordinating Council.
Dr. Kritsonis is author or coauthor of many journal articles. She is also coauthor of one textbook: Fostering Effective Development in Students with Mild Disabilities: A Program Model and Resource Guide. She has prepared more than 200 manuscripts for national publication.
Currently, Dr. Kritsonis is the Online Editor and National Research and Manuscript Preparation Editor for National FORUM Journals. She has assumed this role since 1998. She has also served as Proof Editor and Managing Editor since 1986. Dr. Kritsonis lives in Houston, Texas.

Posted by William Allan Kritsonis, PhD at July 5, 2008 12:36 AM


Neurological Differences between Attention Deficit Hyperactivity Disorder and Childhood Bipolar Disorder


Deborah E. Horn, MS
Instructor – Psychology
Social Science Division
Blinn College
Brenham, Texas
Doctoral Candidate in Clinical Psychology
Argosy University – Dallas
Dallas, Texas

Karen Osterholm, PhD, LPC, LPCS
Assistant Professor
Department of Educational Leadership and Counseling
The Whitlowe R. Green College of Education
Prairie View A&M University
Member of the Texas A&M University System

Mary Alice Kritsonis, EdD
Online Editor
National Research and Manuscript Preparation Editor
National FORUM Journals
Houston, Texas

___________________________________________________________
ABSTRACT
The difficulty of differentially diagnosing attention deficit/hyperactivity disorder (ADHD) and childhood bipolar disorder is discussed from the standpoint of neurological assessment and abnormalities. Research has not addressed this problem. However, studies on each individual disorder are examined. Use of tools such as EEGs, MRIs, fMRIs, and SPECT are discussed.
________________________________________________________________________

Introduction
Diagnosis of childhood disorders is an intricate and challenging process. One reason is many disorders have symptoms overlapping to a significant degree those characterizing other disorders. For example, attention deficit/hyperactivity disorder (ADHD) has many of the same symptoms as childhood bipolar disorder (Fewell & Deutscher, 2002). Misdiagnosing ADHD when the child is actually suffering from childhood bipolar disorder can result. The diagnosis of ADHD would suggest treatment with a stimulant such as Ritalin, Dexedrine, or Benzedrine. However, the administration of such a drug might only serve to induce mania in the child with bipolar disorder. Through the lens of the ADHD label, this increase in hyperactivity might even result in increased dosages of the stimulant, thus exacerbating the mania further. Development of an objective and precise method for accurate differentiation between these two disorders is important. One promising direction may lie in the neurological differences between the two maladies.


Purpose of the Article

The purpose of this article is to discuss differential diagnosing of attention deficit/hyperactivity disorder (ADHD) and childhood bipolar disorder from the standpoint of neurological assessment and abnormalities.

Symptoms

Before examining the neurological differences between ADHD and childhood bipolar disorder, symptoms associated with each will be identified. ADHD involves five categories of symptoms that the client must match before diagnosis, according to the DSM-IV-TR (APA, 2000). The first category consists of two groups. The first group is associated with inattention that has been evident for a minimum of six months and interferes with the individual’s functioning. Examples include losing objects, failing to finish projects or tasks, inability to stay on task, and inability to listen to others. The second group consists of hyperactivity-impulsivity behaviors that interfere with overall functioning. Examples are inability to remain still, difficulty remaining seated, problems with turn taking, and interrupting frequently. Symptoms must have manifested before the age of seven. The disorder must be demonstrated in two different locations, e.g. school and home. “There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning” (p. 93). Lastly, diagnosis requires that the symptoms not appear associated with other difficulties such as mood, anxiety, or dissociative disorders.
Many children with ADHD may also present with symptoms derived from their experiences as sufferers of the disorder. For example, it is not unusual for ADHD children to have a history of accidents such as broken bones, falls, and other accidents. Impulsivity may render the child inattentive to safety measures. The child might also suffer from low self-esteem and subsequent depression related to having been teased and experiencing other difficulties with social interactions.
Bipolar disorder is somewhat difficult to diagnose in children simply because this problem is seen more often in the adult population. In fact, the DSM-IV-TR (APA, 2000) reports that bipolar conditions are often first seen during the twenties rather than earlier in life. Various types and levels of bipolar disorder have been described. Basically, however, the disorder involves periods of mania and depression occurring sequentially or simultaneously. Symptoms of depression in children might include irritable mood, crying, anhedonia, less than expected weight gain for growing children, sleep difficulties, psychomotor agitation, low self-esteem, feelings of guilt, deficits in thinking, and possibly thoughts of suicide. Symptoms of mania for children include high self-esteem, finding sleep unnecessary, talkative periods, racing thoughts, and distractibility.
When comparing these symptoms to those of ADHD, considerable overlap is evident. Consequently, children presenting with such symptoms are more likely diagnosed with the disorder considered the most common in children – ADHD. However, crying, anhedonia, failure to make developmentally appropriate weight gains, suicidal thoughts, and high self-esteem do not seem to be associated with ADHD. Thus, further evaluation is warranted when children present with the latter set of characteristics as well as ADHD symptoms.
In summary, it appears that the child with ADHD may present with greater attention problems than the child who has bipolar disorder. The child with bipolar may demonstrate greater or more intense emotional reactions or difficulties. However, this dichotomy is not a perfect one and would not necessarily be sufficient for differential diagnosis of these two disorders. In extreme examples of both maladies, differentiation might be more readily accomplished. In the majority of cases, which involve more moderate symptoms, the distinction is more difficult.


Etiology

When etiology is explored as a possible differentiation tool, the most prominent theory involves genetics (Fletcher-Janzen & Reynolds, 2003). Since both disorders seem to have familial associations, examination of family histories may aid differential diagnosis. Children with ADHD and those with bipolar disorder are more likely to have relatives with “matching” diagnoses. However, effectiveness of this tool may be limited because relatives might have been misdiagnosed as well.
Accurate diagnosis is critical. “Among adolescents diagnosed with BAD [Bipolar Affective Disorder], around 20% make serious suicide attempts” (Fletcher-Janzen & Reynolds, 2003, p. 87). Additionally, both the bipolar and the ADHD adolescent are likely to engage in criminal behaviors if they are untreated. Manic states and impulsive behaviors increase risk- taking and consequent injury or arrest.
Some theories regarding the etiology of ADHD suggest that this disorder results from minimal brain damage. “Brain damage as a result of infection, trauma, and complications during pregnancy or at the time of delivery has been postulated as potential causes [sic] of ADHD; however, routine neurological examination of children with ADHD is generally normal” (Fletcher-Janzen & Reynolds, 2003, p. 74).
Masi and associates (2003) determined that many children and adolescents diagnosed with ADHD are subsequently diagnosed with bipolar disorder. They suggest that the two difficulties are comorbid but do not consider the possibility that ADHD is a misdiagnosis of bipolar disorder that has not yet completely manifested itself. In other words, the early stages of bipolar disorder may be erroneously identified as ADHD.

Neurological Deficits Associated with ADHD
Brain damage is not always detectable through analysis of scans or wave recordings, but such damage may be assumed on the basis on neurological test results. For example, Temple and Sanfilippo (2003) believe that ADHD is associated with impairments in the executive functions, which might develop from frontal lobe damage. Many ADHD children have a history of injuries such as broken bones. Perhaps their first injury involved frontal closed-head trauma, resulting in increased injury-proneness and deficits in areas of attention. Unfortunately, a child who has bipolar disorder might also exhibit attention deficiencies, especially when she or he experiences depression with associated concentration difficulties.
Support for the hypothesis that ADHD results from brain injury is found in the fact that many ADHD children have seizure disorders, which can also originate from brain trauma (Schubert, 2005). This relationship may render it difficult to determine whether an individual’s ADHD behavior is due to inattention or subclinical seizures, an important distinction given the differential treatment indicated for these two circumstances. The question can be resolved through the use of EEGs because this method can distinguish whether an individual is experiencing a particular type of seizure or is simply not attending. The EEG will also provide evidence of the frequency of subclinical spiking, which may affect the ability to attend as well as other cognitive functions. Consequently, EEGs may lead to relatively simple ways of diagnosing ADHD.
Interestingly, some experts believe that ADHD treatment can be enhanced due to the plasticity of the brain (Ito, 2004). In other words, the child’s brain could be retrained so that she or he could focus and sustain attention within the normal range of functioning. Training in attention maintenance, particularly utilizing treatment protocols involving CBT methods, seems helpful in alleviating some problems for ADHD children.
In an attempt to use brain scans to predict development of ADHD, Wang and Kuo (2003) used gray-scale transfrontal sonography to detect abnormalities in the arteries supplying blood to the basal ganglia. Vasculopathy was detected in infants who later developed ADHD, tics, or obsessive-compulsive behaviors. Whether these abnormalities can be detected beyond infancy has not been established.
Sowell and associates (2003) were able to find peculiarities in the brains of individuals with ADHD by using high resolution MRIs. The findings of their research indicated:
Abnormal morphology was noted in the frontal cortices of patients with attention-deficit hyperactivity disorder, with reduced regional brain size localized mainly to inferior portions of dorsal prefrontal cortices bilaterally. Brain size was also reduced in anterior temporal cortices bilaterally. Prominent increases in grey matter were recorded in large portions of the posterior temporal and inferior parietal cortices bilaterally. (p. 1699)

These researchers’ interpretation of results is that all lobes (with the exception of the occipital) are association cortices of the hetermodal type comprising a complex system throughout the nervous system. This becomes the basis of inhibitory responses and attention. Such “identified region-specific anatomical abnormalities in cortical components of attentional systems … may help better account for the symptoms of attention-deficit hyperactivity disorder” (p. 1699).
Use of the Single Photon Emission Computed Tomography (SPECT) also appears helpful in determining whether an individual has ADHD (Vles, Feron, Hendriksen, Jolles, van Kroonenburgh, & Weber, 2003). Vles and associates used SPECT to examine the brain dopamine transporter and receptor activity, finding that abnormalities were present prior to the use of stimulants. After stimulant treatment began, they found a down-regulation of the transporter system of dopamine. Consequently, an examination of the brain dopamine system might be one diagnostic method for ADHD.
Thus, it would seem diagnosis of ADHD might be supported by certain neurological assessments. The first would involve neurological examinations that directly assess attention. However, childhood attention tests that could differentiate between ADHD and attention problems resulting from mood disorders would be ideal. A neurological examination that consists of EEGs that would detect seizure activity would also be important, since subclinical seizure activity might underlie ADHD. Additional use of MRIs and SPECTs would also assist in the diagnosis of ADHD. These assessments might aid the clinician in ruling out bipolar disorder. However, it is crucial that further research be conducted with specific reference to these two disorders in order to establish valid protocols of assessment.


Neurological Deficits Associated with Childhood Bipolar Disorder
Very little research has been conducted with children diagnosed with pediatric bipolar disorder, especially with regard to neurological deficits. Hence, the majority if not all of the research presented is based on adult subjects unless otherwise stated. Considerable investigation is needed with adequate data analysis related to the neurological deficits and difficulties of this particular population. Whether or not research on adults can be extrapolated to children has not been determined.
Frey and associates (2005) studied neurometabolites in the dorsolateral prefrontal cortex. They found that the phosphoinositide-signaling pathway was not operating normally for individuals in the manic phase of bipolar disorder. The researchers noted that further investigation with regard to manic and depressive states is necessary to determine how this abnormality impacts the bipolar individual.
Ahn and other researchers (2004) note abnormal differences between white matter in individuals without bipolar disorder and those with bipolar disorder. By taking slices of magnetic resonance images of white matter, the researchers were able to examine them for prevalence and severity of hyperintensities. Individuals with bipolar had an abnormal number of white matter hyperintensities. Other researchers have found similar results in studies that investigated white matter hyperintensities in bipolar patients. Craven, James, and Murphey (2002) noted that when individuals have cerebral palsy, the probability is high that bipolar disorder is present as well. They report finding an association with white matter lesions in these two disorders in adolescents. However, it should be noted that others believe that white matter hyperintensities might be due to treatment with lithium (Breeze, Hesdorffer, Hong, Frazier, & Reshaw, 2003). Thus, the medication generally considered the treatment of choice might produce abnormalities within the brain, and these abnormalities could be misinterpreted as resulting from the disorder itself.
One of the primary difficulties in studying bipolar disorder is that there are different types of bipolar, such as bipolar I and bipolar II. McGrath and associates (2004) reviewed the literature regarding comparisons of neurobiological differences between the two types and found that few studies examined this difference. Those in evidence yielded inconclusive results. The authors noted that research on genetic differences implied dissimilarities between the two types.
The functional MRI is recognized as the most useful tool for detecting abnormalities in the brain structure of individuals with bipolar disorder (Malhi, Lagopoulos, Owen, & Yatham, 2004). Malhi and associates drew this conclusion after reviewing the literature related to analysis of neurological abnormalities in bipolar patients. They noted that the majority of studies reporting differences used the fMRI. Specifically, they suggest, “the patterns of fMRI activation are different to those found in healthy subjects and patients with major depression. FMRI studies are likely to provide valuable insights into the pathophysiology of bipolar disorder” (p. 46).
In summary, it does appear that neurological differences provide indicators that bipolar disorder is present. Whether or not these differences are present in children is unknown. It would seem that the fMRI is the most widely used assessment tool in investigating bipolar disorder. Using fMRI in examining children with bipolar disorder would be an important step toward understanding the neurological differences such children exhibit.

Concluding Remarks

Assessment of the limbic system is one area of neurological investigation with great promise for differentiation between children with ADHD and children with bipolar disorder. Malhi, Lagopoulos, Ward, Kumari, Mitchell, Parker, Ivanovski, and Sachdev (2004) report that fMRIs successfully differentiated between bipolar and normal individuals who were presented with positive and negative captioned pictures. They “conclude that bipolar depressed patients perhaps recruit additional subcortical limbic systems for emotional evaluation and this may reflect state-related or trait-related dysfunction. The differential patterns of activation inform us about bipolar depression and have potential diagnostic and therapeutic significance” (p. 741).
One difficulty in comparing neurological research conducted with ADHD subjects and with bipolar subjects is that different tools are likely to be used in assessing the two disorders. Functional MRIs are typically utilized when the research involves bipolar individuals. ADHD individuals are typically investigated with EEGs, MRIs, and SPECT. This makes it difficult to make comparisons between the two disorders in terms of abnormalities. It does seem that both difficulties involve the prefrontal lobe of the cortex. The limbic system is also involved in the neurological pathology of the bipolar patient, but it does not appear to be an aspect of ADHD. Thus, this area is most likely to generate the best differential diagnosis in adults when ADHD must be ruled out. Whether it is effective with children has not been explored. Little is known about limbic system development in the maturing child. Thus, identification of abnormalities in the immature limbic system might not allow the degree of specificity needed for diagnostic purposes, especially for ruling out a specific disorder.
Diagnosing children accurately and with specificity is especially important given their position on the developmental timeline. In other words, failure to keep a child on the “road” to normal development might have a long-term impact on her or his life as an adult. For example, children with untreated ADHD might develop academic problems that eventually lead to dropping out of school or development of conduct disorder. Children with untreated bipolar disorder might ultimately become suicidal. Appropriate treatment for correctly identified childhood disorders could assist the child in continuing to develop normally. Thus, further research in this area is necessary before any conclusions can be drawn regarding differential diagnosis of ADHD and bipolar children.


References
Ahn, K. H., Lyoo, I. K., Lee, H. K., Song, I. C., Oh, J. S., Hwang, J., Kwon, J., Kim, M. J., Kim, M., & Renshaw, P. F. (2004). White matter hyperintensities in subjects with bipolar disorder. Psychiatry & Clinical Neurosciences, 58(5), 516-521.
American Psychological Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text revision). Washington, DC: Author.
Breeze, J. L., Hesdorffer, D. C., Hong, X., Frazier, J. A., & Reshaw, P. F. (2003). Clinical significance of brain white matter hyperintensities in young adults with psychiatric illness. Harvard Review of Psychiatry, 11(5), 269-283.
Craven, C., James, A., & Murphey, M. (2002). Cerebral palsy and juvenile-onset bipolar
disorder: A preliminary report. European Child & Adolescent Psychiatry, 11(3), 134-137.
Fewell, R. R., & Deutscher, B. (2002). Attention deficit hyperactivity disorder in very young children: Early signs and interventions. Infants & Young Children: An Interdisciplinary Journal of Special Care Practices, 14(3), 24-32.
Fletcher-Janzen, E., & Reynolds, C. R. (2003). Childhood disorders: Diagnostic desk reference. New York: John Wiley & Sons.
Frey, B. N., Folgierini, M., Nicoletti, M., Machado-Vieira, R., Stanley, J. A., Soares, J. C., & Kapczinski, F. (2005). A proton magnetic resonance spectroscopy investigation of the dorsolateral prefrontal cortex in acute mania. Human Psychopharmacology: Clinical & Experimental, 20(2), 133-139.
Ito, M. (2004). “Nurturing the brain” as an emerging research field involving child neurology. Brain & Development, 26(7), 429-433.
Malhi, G. S., Lagopoulos, J., Owen, A. M., & Yatham, N. (2004). Bipolaroids: Functional imaging in bipolar disorder. Acta Psychiatrica Scandinavica, 110, 46-54.
Malhi, G. S., Lagopoulos, J., Ward, P. B., Kumari, V., Mitchell, P. B., Parker, G. B., Ivanovski, B., & Sachdev, P. (2004). Cognitive generation of affect in bipolar depression: An fMRI study. European Journal of Neuroscience, 19(3), 741-764.
Masi, G., Toni, C., Perugi, G., Travierso, M. C., Millepiedi, S., Mucci, M., & Akiskal, H. S. (2003). Externalizing disorders in consecutively referred children and adolescents with bipolar disorder. Comprehensive Psychiatry, 44(3), 184-189.
McGrath, B. M., Wessels, P. H., Bell, E. C., Ulrich, M., & Silverstone, P. H. (2004).
Neurobiological findings in Bipolar II disorder compared with findings in Bipolar I disorder. Canadian Journal of Psychiatry, 49(12), 794-801.
Schubert, R. (2005). Attention deficit disorder and epilepsy. Pediatric Neurology, 32, 1-10.
Sowell, E. R., Thompson, P. M., Welcome, S. E., Henkenius, A. L. Toga, A. W., & Peterson, B. S. (2003). Cortical abnormalities in children and adolescents with attention-deficit hyperactivity disorder. Lancet, 362(9397), 1699-1707.
Temple, C. M., & Sanfilippo, P. M. (2003). Executive skills in Kleinfelter’s syndrome.
Neuropsychologia, 41(11), 1547-1559.
Vles, J. S., Feron, F. J., Hendriksen, J. G., Jolles, J., van Kroonenburgh, M. J., & Weber, W. E. (2003). Methylphenidate down-regulates the dopamine receptor and transporter system in children with attention deficit hyperkinetic disorder (ADHD). Neuropediatrics, 34(2), 77-80.
Wang, H. S., & Kuo, M. F. (2003). Sonographic lenticulostriate vasculopathy in infancy with tic and other neurological disorders developed after 7 to 9 years of follow-up. Brain & Development, 25, S43-S47.

Posted by William Allan Kritsonis, PhD at July 5, 2008 12:39 AM

Dr. William Allan Kritsonis Helps Doctoral Students and Faculty Members Publish

Seattle Post-Intelligencer – Press Release

In 2007 and 2008, Dr. William Allan Kritsonis, a professor teaching in the PhD Program in Educational Leadership at PVAMU/Member of the Texas A&M University System mentored doctoral students to publish over 125 national refereed, peer-reviewed articles in professional journals; he helped faculty members publish over 98 articles.
During this time, Dr. Kritsonis had a book published by members of the Oxford Round Table in the University of Oxford, Oxford, England. He was also invited to write a history and philosophy of education for the ABC-CIO Encyclopedia of World History.


William Allan Kritsonis, PhD
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Professor
Doctor of Philosophy Program in Educational Leadership
Prairie View A&M University
(Member of the Texas A&M University System)
The Whitlowe R. Green College of Education
Prairie View, Texas 77446

Distinguished Alumnus (2004)
Central Washington University
College of Education and Professional Studies
Ellensburg, Washington

Visiting Lecturer (2005)
Oxford Round Table
Oriel College
University of Oxford
Oxford, England

Editor-in-Chief
NATIONAL FORUM JOURNALS
Founded 1983

Over 4,000 professors in higher education have published in NATIONAL FORUM JOURNALS
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PhD, University of Iowa, Iowa City, Iowa, 1976
M.Ed. Seattle Pacific University, Seattle, Washington, 1971
B.A. Central Washington University, Ellensburg, Washington
Visiting Scholar, Columbia University, Teachers College, New York, 1981
Doctor of Humane Letters, School of Graduate Studies, Southern Christian University, 2008

Dr. Kritsonis published two articles in the Encyclopedia of Educational Leadership and Administration published by SAGE Publications, Thousand Oaks, California.
In summary, Dr. Kritsonis helped doctoral and faculty members in the PhD Program in Educational Leadership at PV publish over 200 national refereed articles in professional periodicals. Over 80 of these articles are indexed in the national data base system ERIC (Education Resources Information Center).

Posted by William Allan Kritosnis, PhD at July 5, 2008 1:42 PM

Effective Teaching in the Elementary School

William Allan Kritsonis, PhD
Mary Ann Springs


Price: $20.00 All Others
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ISBN 977-1-5130-5741-0 Paper


Effective Teaching in the Elementary School
By William Allan Kritsonis, PhD & Mary Ann Springs


TABLE OF CONTENTS

Preface V

Chapter 1 Develop a Good Elementary Reading Program 1

Chapter 2 Develop a Successful Elementary Classroom Guidance Program 5

Chapter 3 Handle Discipline in the Elementary Classroom 8

Chapter 4 Discover Dropouts Before They Cop Out 12

Chapter 5 Handle Transportation Problems 15

Chapter 6 How to Make Beginning Teachers and New Staff Feel Welcome 17

Chapter 7 Prepare for the Opening and Closing of School 19

Chapter 8 Develop a Successful Intramural Program 23

Chapter 9 Plan Field Trips 26

Chapter 10 Establish a Study Center in the Classroom 30

Chapter 11 Use Instructional Materials and Audio-Visual Aids in the Classroom 32

Chapter 12 Use the Library More Effectively 34

Chapter 13 Participate in the School Faculty Meeting 37

Chapter 14 Banish Forever the Fear of Principal Observations 39

Chapter 15 How to Implement Team Teaching 41

Chapter 16 Develop Strong Public Relations Using the Elementary Classroom 44

Chapter 17 Use the Elementary Assembly to Benefit Students 47

Chapter 18 Make PTA/PTO/PTSO Meaningful for Both Parent and Teacher 49

Chapter 19 Conference with Parents and Evaluate the Success of the Meeting 51

Chapter 20 The Adolescent’s Perception of Failure 55

About the Authors 60

Posted by William Allan Kritsonis, PhD at July 5, 2008 1:44 PM

Order Information

Ways of Knowing Through the Realms of Meaning
A Philosophy for Selecting the Curriculum for General Education
(858 pages) ISBN 0-9770013-3-4—$119.00 (2007)
By
William Allan Kritsonis, PhD
Professor
PhD Program in Educational Leadership
Prairie View A&M University—Member of the Texas A&M University System

———————————————————————————————————
Dr. Kritsonis
Distinguished Alumnus (2004) Central Washington University College of Education and Professional Studies, Ellensburg, Washington
Invited Visiting Lecturer (2005) Oxford Round Table, University of Oxford, Oxford, England
_________________________________________________________________________________________

Published in the United States of America in cooperation with financial support of Visiting Lecturers, OXFORD ROUND TABLE (2005), Oriel College in the University of Oxford, Oxford, England. Distributed by NATIONAL FORUM JOURNALS in the United States of America.
Contains 53 illustrations.

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Posted by William Allan Kritsonis, PhD at July 5, 2008 1:46 PM

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Practical Applications of Educational Research and Basic Statistics

William Allan Kritsonis, PhD
Prairie View A&M University

Copyright 2007/2008 by William Allan Kritsonis, PhD

Except as permitted under the United States Copyright Act Of 1976, no part of this professional publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the proper written permission of Dr. William Kritsonis. Absolutely no unauthorized reproduction of this text.

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Posted by William Allan Kritsonis, PhD at July 5, 2008 1:47 PM


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WILLIAM KRITSONIS, PHD on SCHOOLING
Historical – Philosophical – Contemporary Events and Milestones

362 Pages
2002
ISBN 0-935545-01012
$69.96 United States
$79.95 Canada
$89.95 All Others

Table of Contents

Chapter 1 Introduction to American Schooling Chapter 11 Career Opportunities and Schooling
Chapter 2 History of American Schooling Chapter 12 Teacher Preparation in America
Chapter 3 Philosophies of Schooling and Schooling
Chapter 4 Controlling Schooling in America Chapter 13 Educational Technology and
Chapter 5 Legal Issues in American Schooling Schooling
Chapter 6 Early Childhood Schooling Chapter 14 Future of American Schooling
Chapter 7 Elementary School in America Chapter 15 Important Legalities Affecting
Chapter 8 Secondary Schooling in America Chapter 16 Vocabulary Development
Chapter 9 Special Schooling in America and Improvement
Chapter 10 Educational Administration in America

WILLIAM KRITSONIS, PHD on SCHOOLING is intended for teachers, school administrators, school board members, consultants, community leaders, parents, and many others interested in improving schools in America.

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Posted by William Allan Kritsonis, PhD at July 5, 2008 1:49 PM


Dr. William Allan Kritsonis – Featured Article

Neurological Differences between Attention Deficit Hyperactivity Disorder and Childhood Bipolar Disorder


Deborah E. Horn, MS
Instructor – Psychology
Social Science Division
Blinn College
Brenham, Texas
Doctoral Candidate in Clinical Psychology
Argosy University – Dallas
Dallas, Texas

Karen Osterholm, PhD, LPC, LPCS
Assistant Professor
Department of Educational Leadership and Counseling
The Whitlowe R. Green College of Education
Prairie View A&M University
Member of the Texas A&M University System

Mary Alice Kritsonis, EdD
Online Editor
National Research and Manuscript Preparation Editor
National FORUM Journals
Houston, Texas

___________________________________________________________
ABSTRACT
The difficulty of differentially diagnosing attention deficit/hyperactivity disorder (ADHD) and childhood bipolar disorder is discussed from the standpoint of neurological assessment and abnormalities. Research has not addressed this problem. However, studies on each individual disorder are examined. Use of tools such as EEGs, MRIs, fMRIs, and SPECT are discussed.
________________________________________________________________________

Introduction
Diagnosis of childhood disorders is an intricate and challenging process. One reason is many disorders have symptoms overlapping to a significant degree those characterizing other disorders. For example, attention deficit/hyperactivity disorder (ADHD) has many of the same symptoms as childhood bipolar disorder (Fewell & Deutscher, 2002). Misdiagnosing ADHD when the child is actually suffering from childhood bipolar disorder can result. The diagnosis of ADHD would suggest treatment with a stimulant such as Ritalin, Dexedrine, or Benzedrine. However, the administration of such a drug might only serve to induce mania in the child with bipolar disorder. Through the lens of the ADHD label, this increase in hyperactivity might even result in increased dosages of the stimulant, thus exacerbating the mania further. Development of an objective and precise method for accurate differentiation between these two disorders is important. One promising direction may lie in the neurological differences between the two maladies.


Purpose of the Article

The purpose of this article is to discuss differential diagnosing of attention deficit/hyperactivity disorder (ADHD) and childhood bipolar disorder from the standpoint of neurological assessment and abnormalities.

Symptoms

Before examining the neurological differences between ADHD and childhood bipolar disorder, symptoms associated with each will be identified. ADHD involves five categories of symptoms that the client must match before diagnosis, according to the DSM-IV-TR (APA, 2000). The first category consists of two groups. The first group is associated with inattention that has been evident for a minimum of six months and interferes with the individual’s functioning. Examples include losing objects, failing to finish projects or tasks, inability to stay on task, and inability to listen to others. The second group consists of hyperactivity-impulsivity behaviors that interfere with overall functioning. Examples are inability to remain still, difficulty remaining seated, problems with turn taking, and interrupting frequently. Symptoms must have manifested before the age of seven. The disorder must be demonstrated in two different locations, e.g. school and home. “There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning” (p. 93). Lastly, diagnosis requires that the symptoms not appear associated with other difficulties such as mood, anxiety, or dissociative disorders.
Many children with ADHD may also present with symptoms derived from their experiences as sufferers of the disorder. For example, it is not unusual for ADHD children to have a history of accidents such as broken bones, falls, and other accidents. Impulsivity may render the child inattentive to safety measures. The child might also suffer from low self-esteem and subsequent depression related to having been teased and experiencing other difficulties with social interactions.
Bipolar disorder is somewhat difficult to diagnose in children simply because this problem is seen more often in the adult population. In fact, the DSM-IV-TR (APA, 2000) reports that bipolar conditions are often first seen during the twenties rather than earlier in life. Various types and levels of bipolar disorder have been described. Basically, however, the disorder involves periods of mania and depression occurring sequentially or simultaneously. Symptoms of depression in children might include irritable mood, crying, anhedonia, less than expected weight gain for growing children, sleep difficulties, psychomotor agitation, low self-esteem, feelings of guilt, deficits in thinking, and possibly thoughts of suicide. Symptoms of mania for children include high self-esteem, finding sleep unnecessary, talkative periods, racing thoughts, and distractibility.
When comparing these symptoms to those of ADHD, considerable overlap is evident. Consequently, children presenting with such symptoms are more likely diagnosed with the disorder considered the most common in children – ADHD. However, crying, anhedonia, failure to make developmentally appropriate weight gains, suicidal thoughts, and high self-esteem do not seem to be associated with ADHD. Thus, further evaluation is warranted when children present with the latter set of characteristics as well as ADHD symptoms.
In summary, it appears that the child with ADHD may present with greater attention problems than the child who has bipolar disorder. The child with bipolar may demonstrate greater or more intense emotional reactions or difficulties. However, this dichotomy is not a perfect one and would not necessarily be sufficient for differential diagnosis of these two disorders. In extreme examples of both maladies, differentiation might be more readily accomplished. In the majority of cases, which involve more moderate symptoms, the distinction is more difficult.


Etiology

When etiology is explored as a possible differentiation tool, the most prominent theory involves genetics (Fletcher-Janzen & Reynolds, 2003). Since both disorders seem to have familial associations, examination of family histories may aid differential diagnosis. Children with ADHD and those with bipolar disorder are more likely to have relatives with “matching” diagnoses. However, effectiveness of this tool may be limited because relatives might have been misdiagnosed as well.
Accurate diagnosis is critical. “Among adolescents diagnosed with BAD [Bipolar Affective Disorder], around 20% make serious suicide attempts” (Fletcher-Janzen & Reynolds, 2003, p. 87). Additionally, both the bipolar and the ADHD adolescent are likely to engage in criminal behaviors if they are untreated. Manic states and impulsive behaviors increase risk- taking and consequent injury or arrest.
Some theories regarding the etiology of ADHD suggest that this disorder results from minimal brain damage. “Brain damage as a result of infection, trauma, and complications during pregnancy or at the time of delivery has been postulated as potential causes [sic] of ADHD; however, routine neurological examination of children with ADHD is generally normal” (Fletcher-Janzen & Reynolds, 2003, p. 74).
Masi and associates (2003) determined that many children and adolescents diagnosed with ADHD are subsequently diagnosed with bipolar disorder. They suggest that the two difficulties are comorbid but do not consider the possibility that ADHD is a misdiagnosis of bipolar disorder that has not yet completely manifested itself. In other words, the early stages of bipolar disorder may be erroneously identified as ADHD.

Neurological Deficits Associated with ADHD
Brain damage is not always detectable through analysis of scans or wave recordings, but such damage may be assumed on the basis on neurological test results. For example, Temple and Sanfilippo (2003) believe that ADHD is associated with impairments in the executive functions, which might develop from frontal lobe damage. Many ADHD children have a history of injuries such as broken bones. Perhaps their first injury involved frontal closed-head trauma, resulting in increased injury-proneness and deficits in areas of attention. Unfortunately, a child who has bipolar disorder might also exhibit attention deficiencies, especially when she or he experiences depression with associated concentration difficulties.
Support for the hypothesis that ADHD results from brain injury is found in the fact that many ADHD children have seizure disorders, which can also originate from brain trauma (Schubert, 2005). This relationship may render it difficult to determine whether an individual’s ADHD behavior is due to inattention or subclinical seizures, an important distinction given the differential treatment indicated for these two circumstances. The question can be resolved through the use of EEGs because this method can distinguish whether an individual is experiencing a particular type of seizure or is simply not attending. The EEG will also provide evidence of the frequency of subclinical spiking, which may affect the ability to attend as well as other cognitive functions. Consequently, EEGs may lead to relatively simple ways of diagnosing ADHD.
Interestingly, some experts believe that ADHD treatment can be enhanced due to the plasticity of the brain (Ito, 2004). In other words, the child’s brain could be retrained so that she or he could focus and sustain attention within the normal range of functioning. Training in attention maintenance, particularly utilizing treatment protocols involving CBT methods, seems helpful in alleviating some problems for ADHD children.
In an attempt to use brain scans to predict development of ADHD, Wang and Kuo (2003) used gray-scale transfrontal sonography to detect abnormalities in the arteries supplying blood to the basal ganglia. Vasculopathy was detected in infants who later developed ADHD, tics, or obsessive-compulsive behaviors. Whether these abnormalities can be detected beyond infancy has not been established.
Sowell and associates (2003) were able to find peculiarities in the brains of individuals with ADHD by using high resolution MRIs. The findings of their research indicated:
Abnormal morphology was noted in the frontal cortices of patients with attention-deficit hyperactivity disorder, with reduced regional brain size localized mainly to inferior portions of dorsal prefrontal cortices bilaterally. Brain size was also reduced in anterior temporal cortices bilaterally. Prominent increases in grey matter were recorded in large portions of the posterior temporal and inferior parietal cortices bilaterally. (p. 1699)

These researchers’ interpretation of results is that all lobes (with the exception of the occipital) are association cortices of the hetermodal type comprising a complex system throughout the nervous system. This becomes the basis of inhibitory responses and attention. Such “identified region-specific anatomical abnormalities in cortical components of attentional systems … may help better account for the symptoms of attention-deficit hyperactivity disorder” (p. 1699).
Use of the Single Photon Emission Computed Tomography (SPECT) also appears helpful in determining whether an individual has ADHD (Vles, Feron, Hendriksen, Jolles, van Kroonenburgh, & Weber, 2003). Vles and associates used SPECT to examine the brain dopamine transporter and receptor activity, finding that abnormalities were present prior to the use of stimulants. After stimulant treatment began, they found a down-regulation of the transporter system of dopamine. Consequently, an examination of the brain dopamine system might be one diagnostic method for ADHD.
Thus, it would seem diagnosis of ADHD might be supported by certain neurological assessments. The first would involve neurological examinations that directly assess attention. However, childhood attention tests that could differentiate between ADHD and attention problems resulting from mood disorders would be ideal. A neurological examination that consists of EEGs that would detect seizure activity would also be important, since subclinical seizure activity might underlie ADHD. Additional use of MRIs and SPECTs would also assist in the diagnosis of ADHD. These assessments might aid the clinician in ruling out bipolar disorder. However, it is crucial that further research be conducted with specific reference to these two disorders in order to establish valid protocols of assessment.


Neurological Deficits Associated with Childhood Bipolar Disorder
Very little research has been conducted with children diagnosed with pediatric bipolar disorder, especially with regard to neurological deficits. Hence, the majority if not all of the research presented is based on adult subjects unless otherwise stated. Considerable investigation is needed with adequate data analysis related to the neurological deficits and difficulties of this particular population. Whether or not research on adults can be extrapolated to children has not been determined.
Frey and associates (2005) studied neurometabolites in the dorsolateral prefrontal cortex. They found that the phosphoinositide-signaling pathway was not operating normally for individuals in the manic phase of bipolar disorder. The researchers noted that further investigation with regard to manic and depressive states is necessary to determine how this abnormality impacts the bipolar individual.
Ahn and other researchers (2004) note abnormal differences between white matter in individuals without bipolar disorder and those with bipolar disorder. By taking slices of magnetic resonance images of white matter, the researchers were able to examine them for prevalence and severity of hyperintensities. Individuals with bipolar had an abnormal number of white matter hyperintensities. Other researchers have found similar results in studies that investigated white matter hyperintensities in bipolar patients. Craven, James, and Murphey (2002) noted that when individuals have cerebral palsy, the probability is high that bipolar disorder is present as well. They report finding an association with white matter lesions in these two disorders in adolescents. However, it should be noted that others believe that white matter hyperintensities might be due to treatment with lithium (Breeze, Hesdorffer, Hong, Frazier, & Reshaw, 2003). Thus, the medication generally considered the treatment of choice might produce abnormalities within the brain, and these abnormalities could be misinterpreted as resulting from the disorder itself.
One of the primary difficulties in studying bipolar disorder is that there are different types of bipolar, such as bipolar I and bipolar II. McGrath and associates (2004) reviewed the literature regarding comparisons of neurobiological differences between the two types and found that few studies examined this difference. Those in evidence yielded inconclusive results. The authors noted that research on genetic differences implied dissimilarities between the two types.
The functional MRI is recognized as the most useful tool for detecting abnormalities in the brain structure of individuals with bipolar disorder (Malhi, Lagopoulos, Owen, & Yatham, 2004). Malhi and associates drew this conclusion after reviewing the literature related to analysis of neurological abnormalities in bipolar patients. They noted that the majority of studies reporting differences used the fMRI. Specifically, they suggest, “the patterns of fMRI activation are different to those found in healthy subjects and patients with major depression. FMRI studies are likely to provide valuable insights into the pathophysiology of bipolar disorder” (p. 46).
In summary, it does appear that neurological differences provide indicators that bipolar disorder is present. Whether or not these differences are present in children is unknown. It would seem that the fMRI is the most widely used assessment tool in investigating bipolar disorder. Using fMRI in examining children with bipolar disorder would be an important step toward understanding the neurological differences such children exhibit.

Concluding Remarks

Assessment of the limbic system is one area of neurological investigation with great promise for differentiation between children with ADHD and children with bipolar disorder. Malhi, Lagopoulos, Ward, Kumari, Mitchell, Parker, Ivanovski, and Sachdev (2004) report that fMRIs successfully differentiated between bipolar and normal individuals who were presented with positive and negative captioned pictures. They “conclude that bipolar depressed patients perhaps recruit additional subcortical limbic systems for emotional evaluation and this may reflect state-related or trait-related dysfunction. The differential patterns of activation inform us about bipolar depression and have potential diagnostic and therapeutic significance” (p. 741).
One difficulty in comparing neurological research conducted with ADHD subjects and with bipolar subjects is that different tools are likely to be used in assessing the two disorders. Functional MRIs are typically utilized when the research involves bipolar individuals. ADHD individuals are typically investigated with EEGs, MRIs, and SPECT. This makes it difficult to make comparisons between the two disorders in terms of abnormalities. It does seem that both difficulties involve the prefrontal lobe of the cortex. The limbic system is also involved in the neurological pathology of the bipolar patient, but it does not appear to be an aspect of ADHD. Thus, this area is most likely to generate the best differential diagnosis in adults when ADHD must be ruled out. Whether it is effective with children has not been explored. Little is known about limbic system development in the maturing child. Thus, identification of abnormalities in the immature limbic system might not allow the degree of specificity needed for diagnostic purposes, especially for ruling out a specific disorder.
Diagnosing children accurately and with specificity is especially important given their position on the developmental timeline. In other words, failure to keep a child on the “road” to normal development might have a long-term impact on her or his life as an adult. For example, children with untreated ADHD might develop academic problems that eventually lead to dropping out of school or development of conduct disorder. Children with untreated bipolar disorder might ultimately become suicidal. Appropriate treatment for correctly identified childhood disorders could assist the child in continuing to develop normally. Thus, further research in this area is necessary before any conclusions can be drawn regarding differential diagnosis of ADHD and bipolar children.


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