UIC, Dept. of Psychiatry

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Pediatric Mood Disorders Clinic
Teaching Rounds

ADHD vs. Bipolar Disorder in Children and Adolescents

Judy Tai, MS-3

There is much debate surrounding ADHD and BPD in children and adolescents. Much of this originates from the overlap in symptoms and high frequency of comorbidity between the two disorders. Overlapping symptoms include:

Distractibility
Impulsivity
Hyperactivity
Emotional lability

There is some research that propose that irritability in mania is more violent than in ADHD, using words such as "completely wild", "explosive", "extremely expressive", and "affective storms", to describe the affect of bipolar mania. They also make the distinction that overactivity in children with BPD is more goal-directed, whereas the hyperactivity in ADHD children is more pervasive.

Some other studies have shown that the comorbidity of BPD in ADHD is between 11-20%, and there is a higher likelihood, 57-98%, of finding ADHD in children diagnosed with BPD. When studying the family histories and prevalence of ADHD and BPD in children diagnosed with either or both, it was found that children diagnosed with BPD, were more likely to have parents who also have BPD. However, children diagnosed with ADHD were likely to have parents who were diagnosed with either ADHD or BPD. These studies raise the question of whether childhood-onset BPD and the comorbid condition of ADHD+BPD may be the same disorder. They also raise the question of whether there are any true cases of bipolar disorder in children. Some researchers suggest that perhaps children who meet the criteria for mania are, in fact, severe cases of ADHD with affective dysregulation. Regardless of the distinction, most agree that children who meet criteria for mania have a severe clinical picture that leads to considerable psychiatric and psychosocial disability beyond that conferred by ADHD, and clinicians should be alert to a potential of comorbid bipolar disorder.

References:

Faraone, SV PhD; Biederman, J MD; Wozniak, J MD; Attention-Deficit Hyperactivity Disorder with Bipolar Disorder: A Familial Subtype? J of Am Acad of Child and Adolesc Psych, Oct 1997, 36(10):1378-1387.

Wozniak, J MD; Biederman, J MD, et al; Mania-Like Symptoms Suggestive of CHildhood-Onset Bipolar Disorder in Clinically Referred Children. J of Am Acad of Child and Adolesc Psych, Jul 1995, 34(7):867-876.