Question:
I have consulted on many attention-deficit/hyperactivity disorder
(ADHD) patients in my 25-year practice. In their adulthood, many of
these patients clearly had frank bipolar disorder. Is there any way to
identify those with bipolar from those with ADHD at an early stage?
Answer:
The incidence of ADHD in children who are later diagnosed in adulthood
with bipolar disorder (BD) is indeed quite high. Compounding this
situation is the high rate of co-occurrence of these 2 disorders. In
some series, 93% of children with diagnosed BD have comorbid ADHD,
whereas 59% of adolescents with adolescent-onset mania have ADHD. The
association becomes less pronounced in adults with diagnosed mania, of
whom only 10% have comorbid ADHD.
Symptoms common to both, especially in younger children, include
hyperactivity, inattention, irritability, and rage, with the severity
of these symptoms being more intense in children with BD. Overall
impairment is more profound in individuals with both disorders,
although environmental accommodations, including the provision of
structure, help less to alleviate symptoms in BD than those ascribed to
ADHD.
There are several other clinical distinctions that I use in my practice
to differentiate ADHD from BD. A strong family history of bipolar
disorder is highly supportive of that diagnosis in a particular child.
Children with BD are often "mean" and hurtful in their style of social
interaction, something not typically seen in ADHD. Children with
bipolar disorder can be sexualized to a worrying extent, without any
history of sexual abuse. Comments and actions might make adults in
their environment feel uncomfortable. Grandiose statements regarding
their strengths and abilities might also be a tip-off to BD. Ya think, yeh I might think the same as well. Although never dx'd who
knows what evil lurks in the minds of god in the name of
practioners.... I read once that children with ADD got in trouble by accident, but
children with bipolar got in trouble on purpose.
