I am in hopes that you may be able to enlighten me on some issues.  I am BiPolar and 36 yrs old.  Was diagnosed @ age 16.  I deal with my condition very well and am well informed.  My question is actually geared for my son who is 5 1/2 yrs old.  He is currently taking1 cc Risperdal and 10 mg adderall in the AM and 1 cc Risperdal and 5 mg adderall in the PM.  He has been to many doctors.  A pyschologist diagnosed him as ODD ADHD and OCD.  (when I say diagnosed, I am referring to verbally).  The Nuerologist (child)diagnosed ADHD in writing but has verbally discussed with me that he agreed that my son had ODD and OCD and possibly in the PDD Spectrum.  He is the prescribing doctor for meds.  I requested a letter from him for an IEP for school for my child, all he wrote down was the ADHD though.  My son had a full testing done at a clinic for child development and he had delays is most scores annd note his explosive and inflexable behavior and suggested that BIPOLAR may be a diagnosis for my child.  No one will committ to an actual diagnosis for my son, I don't get it.  He is, in my opinion, far more than ADHD, the meds hes is on would also indicate that to me as well.  My older son is ADHD and they are night and day.  How do I get the attending doctors to give me an actual diagnosis without being so vague about it.  Is Risperdal common for ADHD alone?  Are children with ADHD prone to being highly aggressive and even violent at times, irratable, angry and talking of killing self or others?  This of course with the issues of short to no attention span and hyperactive and impulsivness.  Any suggestions?  Help would be appreciated, I am trying to get my son in the correct school setting as he was recently ask to leave a parochial school.  Thanks much!! Dawn in Illinois

Dear Dawn -- 
Now I'd be way off base to make a diagnosis when other's are making theirs having actually seen your son, right?  So I won't offer one.  I will offer a way of thinking.  It's called Occam's razor.  Named after William of Occam, from the 1300's.  It says "don't  increase, beyond what is necessary, the number of entities required to explain anything".  Or, put more formally:  plurality should not be assumed without necessity (or, in modern English, keep it simple, stupid).  Here's how it might be applied in your situation. 

If your son has one unusual though not rare condition, e.g. ADHD, wouldn't it be quite a coincidence if he also had OCD, another unusual though not rare condition? And wouldn't it then be extremely unlikely that he'd have a third unusual condition? It seems more likely that he has one unusual condition that explains all his symptoms.  Now, what diagnoses have been offered that have the potential to explain all his symptoms with a single diagnosis: aggressive, violent, irritable, hyperactive, impulsive; and suicidal (just listing those you named)?  Think about that, and ask your doctors about that way of thinking and see what they think.  Occam's razor does not always lead to the best way of thinking about something -- it just does so more often than thinking about multiple simultaneous explanations. 

Dr. Phelps  

Published October, 2001