Bipolar Disorder and ADHD: Comorbidity and Diagnostic Distinctions
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Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) are neurodevelopmental disorders with onset in childhood and early adolescence, and common persistence in adulthood. Both disorders are often undiagnosed, misdiagnosed, and sometimes over diagnosed, leading to high rates of morbidity and disability. The differentiation of these conditions is based on their clinical features, comorbidity, psychiatric family history course of illness, and response to treatment. We review recent relevant findings and highlight epidemiological, clinical, family history, course, and treatment-response differences that can aid the differential diagnosis of these conditions in an outpatient pediatric setting.
KeywordsAdolescent Attention deficit-hyperactivity disorder Bipolar disorder Child Clinical features Course Differential diagnosis Treatment
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Conflict of Interest
Ciro Marangoni and Lavinia De Chiara declare that they have no conflict of interest.
Gianni L. Faedda has received royalties for book: “Parenting a Bipolar Child”, New Harbinger Publishing, CA.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.••Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9. Epidemiology of adolescents mental health in the US, with prevalence and mean age of onset for the most common youth mental health issues.PubMedCentralPubMedCrossRefGoogle Scholar
- 3.Hodgkins P, Montejano L, Sasané R, Huse D. Cost of illness and comorbidities in adults diagnosed with attention-deficit/hyperactivity disorder: a retrospective analysis. Prim Care Companion CNS Disord. 2011;13(2):e1–e12.Google Scholar
- 10.•Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65. A meta-analysis of rates of mental illness in different countries, including differences in criteria used, training of clinicians, instruments used for the diagnoses.PubMedCrossRefGoogle Scholar
- 16.Center for Disease Control and Prevention (CDC). Attention-deficit/hyperactivity disorder (ADHD). 2005. Available from: http://www.cdc.gov/ncbddd/adhd/.
- 21.••Birmaher B, Axelson D, Goldstein B, Strober M, Gill MK, Hunt J, et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiatry. 2009;166(7):795–804. Clinical features of bipolar disorder in youths during prospective follow-up of four-years. Some cases of BP-NOS progress to BP-I or –II, while others remain BP-NOS, or fail to persist.PubMedCentralPubMedCrossRefGoogle Scholar
- 24.Nierenberg AA, Miyahara S, Spencer T, Wisniewski SR, Otto MW, Simon N, et al. Clinical and diagnostic implications of lifetime attention-deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biol Psychiatry. 2005;57(11):1467–73.PubMedCrossRefGoogle Scholar
- 27.Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, et al. Higher risk of developing mood disorders among adolescents with comorbidity of attention deficit hyperactivity disorder and disruptive behavior disorder: a nationwide prospective study. J Psychiatr Res. 2013;47(8):1019–23.PubMedCrossRefGoogle Scholar
- 28.•Jerrell JM, McIntyre RS, Park YM. Correlates of incident bipolar disorder in children and adolescents diagnosed with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2014;75(11):e1278–83. A rare prospective study of predictors of bipolar disorder among youths treated for ADHD, including clinical features and treatment response.PubMedCrossRefGoogle Scholar
- 40.Uchida M, Faraone SV, Martelon M, Kenworthy T, Woodworth KY, Spencer TJ, et al. Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis. J Affect Disord. 2014;165:81–6.PubMedCentralPubMedCrossRefGoogle Scholar
- 44.Teicher MH, Faedda GL, Baroni A, McGreenery CE, Hernandez M, Grant MC, et al. Actigraphy rest-activity disturbances discriminate pediatric Bipolar Disorder from attention Deficit Hyperactivity Disorder and typically-developing controls. Biol Psychiatry. 2013;73(1S):312.Google Scholar
- 51.Faedda GL, Marangoni C, Serra G, Salvatore P, Sani G, Vasquez GH et al. Precursors of bipolar disorder: a systematic literature review of prospective studies. J Clin Psychiatry. 2015;76(5):614–24.Google Scholar
- 55.Geller B, Zimerman B, Williams M, Delbello MP, Frazier J, Beringer L. Phenomenology of prepubertal and early adolescent bipolar disorder: examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality. J Child Adolesc Psychopharmacol. 2002;12(1):3–9.PubMedCrossRefGoogle Scholar
- 56.Bohman H, Jonsson U, Päären A, von Knorring L, Olsson G, von Knorring AL. Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC Psychiatry. 2012;12:90.PubMedCentralPubMedCrossRefGoogle Scholar
- 57.Wozniak J, Faraone SV, Martelon M, McKillop HN, Biederman J. Further evidence for robust familiality of pediatric bipolar I disorder: results from a very large controlled family study of pediatric bipolar I disorder and a meta-analysis. J Clin Psychiatry. 2012;73(10):1328–34.PubMedCentralPubMedCrossRefGoogle Scholar
- 62.•Faraone SV, Biederman J, Wozniak J. Examining the comorbidity between attention deficit hyperactivity disorder and bipolar I disorder: a meta-analysis of family genetic studies. Am J Psychiatry. 2012;169(12):1256–66. A meta-analysis of familial transmission of comorbid ADHD and bipolar disorder, showing elevated risk for both conditions.PubMedCrossRefGoogle Scholar
- 64.Arnold LE, Ganocy SJ, Mount K, Youngstrom EA, Frazier T, Fristad M, et al. Three-year latent class trajectories of attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample not selected for ADHD. J Am Acad Child Adolesc Psychiatry. 2014;53(7):745–60.PubMedCentralPubMedCrossRefGoogle Scholar
- 65.Judd LL, Schettler PJ, Akiskal H, Coryell W, Fawcett J, Fiedorowicz JG, et al. Prevalence and clinical significance of subsyndromal manic symptoms, including irritability and psychomotor agitation, during bipolar major depressive episodes. J Affect Disord. 2012;138(3):440–8.PubMedCentralPubMedCrossRefGoogle Scholar
- 66.Kessler RC, Green JG, Adler LA, Barkley RA, Chatterji S, Faraone SV, et al. Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Arch Gen Psychiatry. 2010;67(11):1168–78.PubMedCentralPubMedCrossRefGoogle Scholar
- 68.Ricaurte GA, Mechan AO, Yuan J, Hatzidimitriou G, Xie T, Mayne AH, et al. Amphetamine treatment similar to that used in the treatment of adult attention-deficit/ hyperactivity disorder damages dopaminergic nerve endings in the striatum of adult nonhuman primates. J Pharmacol Exp Ther. 2005;315(1):91.PubMedCrossRefGoogle Scholar
- 69.•Lakhan SE, Kirchgessner A. Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav. 2012;2(5):661–77. A review of medication’ safety of stimulants in ADHD, potential for abuse, overdosing, contraband, withdrawal and effect on cognitive functions.PubMedCentralPubMedCrossRefGoogle Scholar
- 70.Weyandt LL, Oster DR, Marraccini ME, Gudmundsdottir BG, Munro BA, Zavras BM, et al. Pharmacological interventions for adolescents and adults with ADHD: stimulant and nonstimulant medications and misuse of prescription stimulants. Psychol Res Behav Manag. 2014;7:223–49.PubMedCentralPubMedCrossRefGoogle Scholar
- 71.Dols A, Sienaert P, van Gerven H, Schouws S, Stevens A, Kupka R, et al. The prevalence and management of side effects of lithium and anticonvulsants as mood stabilizers in bipolar disorder from a clinical perspective: a review. Int Clin Psychopharmacol. 2013;28(6):287–96.PubMedCrossRefGoogle Scholar