For the past eight months, my 13-year old son has taken medicine for Attention Deficit/Hyperactivity Disorder, but his behavior has not improved. I’ve heard that bipolar disorder in children is sometimes misdiagnosed as Attention Deficit/Hyperactivity Disorder. What symptoms or behaviors should I look for in my son that I could discuss with the pediatrician to make sure the proper diagnosis has been made?

Attention Deficit/Hyperactivity Disorder (ADHD) and Bipolar Disorder share certain symptoms, yet differ in symptom intensity, variety and treatment. ADHD alone impairs only attention and activity; there are no mood or aggression symptoms. ADHD commonly shares a second illness such as Oppositional Defiant Disorder, Conduct Disorder, Depression, Bipolar Disorder or Substance Abuse that may have mood or aggression problems. About 90% of people with bipolar disorder also have ADHD. To aid in early diagnosis of bipolar disorder, a study at the National Institutes of Mental Health cited five key symptoms of grandiosity, suicide gesture, irritability, decreased attention and racing thoughts. Separation of these illnesses is clarified by symptoms common in bipolar and less common in ADD/ADHD:

• Strong family history of bipolar disorder
• Episodic disruptive behavior, with seasonal variation or with menstrual cycles
• Sexually inappropriate behaviors
• Psychotic or atypical depression
• Medicine-induced mania with poor response to stimulants or antidepressants
• Intense anger, temper tantrums or meltdowns
• Poor judgment, inflated sense of self-importance, daredevil behavior
• Compulsive bursts of creativity and activity
• Great capacity for eliciting emotional responses in others

When you visit your pediatrician, report any positive findings in your child and ask about bipolar disorder. Most pediatricians tend to refer children with bipolar problems to Child & Adolescent Psychiatrists for consultation about diagnosis and treatment. Helpful books include The Bipolar Child* and Survival Strategies for Parenting Children with Bipolar Disorder.*

Linda Bock, MD
St. Louis, MO

*Editor's Note: These books and others may be purchased at Amazon.com directly from this website.  Click here.

Symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) overlap with those of childhood bipolar disorder. Some distinctions are:

Moods - Moods of children with both disorders can change quickly, but ADHD kids generally do not display depression as a predominant symptom as do bipolar kids.

Outbursts - Duration and intensity of tantrums usually differ. ADHD kids usually calm down within 30 minutes whereas bipolar kids may act out for hours. Destructiveness occurs in both disorders but those with ADHD often are destructive from carelessness. Bipolar kids’ outbursts usually occur due to anger with increased amounts of energy, sometimes resulting in violence.

Triggers - Triggers differ; bipolar kids generally react when limits are set; ADHD kids typically are triggered by overstimulation.

Sleep - Children with ADHD usually awaken quickly and become alert within minutes; bipolar kids have difficulty awakening, becoming alert and can be irritable for hours. They often have gruesome, gory nightmares.

Dangerousness – ADHD kids may engage in dangerous behaviors and are often unaware of danger; whereas bipolar kids tend to be risk-takers.

Sexual Behavior - Children with bipolar disorder tend to have early sexual interest and behavior.

Other Considerations - Children with ADHD generally respond to stimulants. Bipolar children usually respond to mood stabilizers and often become manic from stimulants. Therefore, mood disorders should be ruled out prior to diagnosing ADHD. Family history is important as bipolar kids generally have relatives with mood disorders.

Sherri G. Harris, M.S.W., L.C.S.W.
1750 S. Brentwood Blvd.
St. Louis, Missouri 63144
314-968-2111

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