Dr. Grossi's Blog

Pediatric Bipolar Disorder vs ADHD

Dr. Philip Grossi
Thursday, 07 May 2015

One of the most common questions that arise in the office involves distinguishing between juvenile bipolar disorder and ADHD. Contributing to the difficulty is the finding that BPD and ADHD are co-morbid at least 50% of the time, i.e., those individuals meet criteria for both disorders. A further difficulty in drawing the distinction is that they are clinical diagnoses so by definition there is no test, scale, laboratory test or scan which precisely diagnoses the disorders.

There are historical and clinical characteristics that help to distinguish the two disorders. From a family history standpoint, children of parents who have BD are 13 times more likely to have BD than controls and twice as likely to have anxiety disorders as controls.  From a clinical standpoint adolescents with BD tend to display shifts in energy level from high to low or vice versa. Moods accompanying these energy shifts range from silliness, meddlesomeness, intrusive behavior, elation, expansive, belligerent, angry,and irritable, to sadness, gloominess, depression, and suicidal preoccupation. Other features may include decreased need for sleep, increased talkativeness, and the sense that the child's thoughts are racing, increased destructibility, and increased in work out put and risk taking behaviors.

When comparing patients with ADHD to those with BD those with BD had more mood elevation, grandiosity, racing thoughts, decreased need for sleep and hypersexuality. Both groups shared hyperactivity, distractibillity, pressured speech. and irritability. These were thus not helpful in making the distinction.

ADHD is found in 6-7% of US children with a greater prevalence in boys than girls. BD is equally distributed in girls and boys. If one takes a cohort of 100 5 year olds who meet the criteria for ADHD and they are reassessed every year, when they reach 25 years of age only 66 % continue to meet criteria, the other 34 % fall out of the category.  Those that continue to meet criteria at 25 will likely have the symptoms the rest of their lives. About 80% of children who meet criteria for ADHD meet criteria for at least one other disorder including learning disabilities, anxiety disorders, depression, and bipolar disorder. Children with ADHD have a low frustration tolerance which leads to aggressive behavior and anger episodes. In BD anger episodes and aggressive behavior arises out of irritable mood. While ADHD and BD can overlap, they each have some distinguishing features described above

There are some additional clinical findings found in BD children.  Those include marked irritability, oppositional behavior, frequent mood swings, distractability, hyperactivity, impulsivity, restlessness, giddiness or goofiness, racing thoughts, aggressive behavior, grandiosity, carbohydrate cravings, depressed mood, exhaustion, low self-esteem,  trouble getting up in the morning, and marked sensitivity to environmental stimuli and separation anxiety. Other symptoms somewhat less common include bed-wetting, night terrors, pressured speech, obsessional behavior, compulsive behavior, tics, learning disabilities, poor short term memory, poor organization, fascination with blood and guts, hypersexuality, manipulative behavior, bossy or bullying behavior, lying, suicidal thoughts, destructiveness, paranoia, and hallucinations and delusions.