Differentiating between ADHD and Bipolar Disorder is difficult and highly challenging but important because mistakes can mean the wrong medicine and the wrong treatment.
Currently, we don’t quite understand the relationship between ADHD and Bipolar Disorder but research continues to suggest connections. We are learning more every day. In 2019 a group of doctors discovered that the same group of genes contributes to five illness ADHD autism, bipolar disorder, major depression and schizophrenia.
What is clear.
Adhd and bipolar disorder have a great deal of overlap and it is important to do the best job possible discerning in a child sifting through the overlap to determine what is causing your child's symptoms, because therapy and medication is different.
Some adults and children initially diagnosed with ADHD, later go on to be diagnosed with bipolar disorder. In some cases, they may have been misdiagnosed initially with ADHD when they had bipolar disorder. It may mean these kids had both ADHD and Bipolar Disorder or perhaps the symptoms of ADHD somehow evolve into bipolar disorder! Or, maybe our system for diagnosing ADHD and Bipolar disorder may be flawed. We are continuously refining and trying to understand these illness better. These are questions that we don't know the answers to.
In my practice I have worked with kids who have both Bipolar and ADHD, or who have been misdiagnosed with one or the other.
For purposes of this page, I will highlight the things you need to know as a parent when advocating for help for your child.
If a doctor makes the wrong diagnosis of ADHD when a child has Bipolar Disorder it can be very harmful. If a doctor incorrectly diagnosis a child with Bipolar Disorder, it can also be harmful.
My caseload is filled with children who were harmed by being medicated for ADHD when they had a mood disorder. Children with Bipolar disorder who are given stimulants and antidepressants may become significantly worse. This worsening of symptoms includes experiencing more mania, aggression, or rapid cycling. Children with ADHD do not seem to become worse with mood stabilizers, however, mood stabilizers have serious side effects! No one wants to put their child on serious medications if they don't have to.
When I worked with children in the foster care system, I saw them routinely misdiagnosed and over-medicated.
Children with co-occurring ADHD and Bipolar will likely first have their mood stabilized by your doctor before a stimulant or antidepressant is added. If these medicines are added, they are normally started at a low dose and slowly raised, with careful attention to side effects. Ask questions about this if something different is being done.
Unless a child has responded positively to a mood stabilizers ( are stable), it is difficult to get a true picture of whether there are two distinct disorders. Children may experience distractability, restlessness, and fluctuations in attention and concentration that vary with mood states. Sometimes when the child is stable these symptoms go away. How would we know if it was from the ADHD or Bipolar disorder if a child was not stable?
So the best plan if a child appears to have both of these diagnoses is to work with a good psychiatrist and get their mood stable. Than you will have a truer picture of whats really going on with your child.
ADHD WITH (NON-SPECIFIC) MOOD DISORDER
(Dearborn Hts. MI (USA))
My son is 13 and recently diagnosed with a mood disorder. He has been diagnosed with ADHD since he was 3. Currently, still having to take meds for that, and due to an episode he had with contemplating suicide, he now takes Depakote as well. He has explosive moments from time to time, especially when frustrated as well as feeling misunderstood.
I am currently doing some research on the combination of the two disorders for a psychology class and would appreciate any information you can provide as well as additional sites that may provide some answers to the following questions.
Does one trigger the other?
We do not know the answer to this. There is much controversy over whether or not the current diagnostic categories in the DSM are accurate. There is a lot of speculation that clusters of symptoms just tend to co-occur, and that they are not distinctly different diagnoses
What parts of the brain does it affect?
The ADHD brain has impairment in:
The Frontal Cortex (which controls attention executive function and organization). The Limbic System (which regulates emotions and attention), the basal ganglia (which can result in impulsivity and inattention).
It also has impairments in the Reticular Activating System or (RAS). A system that relays messages around the brain. Finally the ADHD brain has low levels of dopamine.
We also know children with ADHD have a frontal lobe that develops slower which explains their delay of several years behind their peers with social maturation, cause and effect and life skills.
The Bipolar Brain has impairment in: The Frontal Cortex which is smaller but research shows with Lithium treatment it is reversible. The Bipolar Brain also alterations in cortical thickness surface area and gray matter.
Are the two possibly related? Yes. See this link
Can the medication that he was taking (strattera and concerta)at the time before being diagnosed influence the mood swings?
We believe these medications may exacerbate the illness long term, and we know that these medications often immediately worsen mood states.
Are they hereditary?
Bipolar Disorder has a strong genetic basis, but we don't entirely understand it.
Are there some behavior modification suggestions?
There are clear behavioral modifications for ADHD. You can learn some about treatment here. Traditional Behavioral modification is not an effective tool with BPD.
Do you find that these disorders are common among some social classes more than others?
No. Although African Americans may be more likely to be diagnosed with ADHD and ODD, in my experience, often incorrectly.
ADHD, BIPOLAR , OR ODD MISDIAGNOSIS AND CROSSOVER
by Andy's mom
We are in the process of having our child (7 years) evaluated for various disorders. He was just tested positive for the sensory disorder (he seeks sensory stimuli) and that he is 2 years developmentally delayed.
The therapists and counselor is looking for one of the following: Bipolar, pervasive development, ADHD, and ODD. I know many of these disorders have crossed over type symptoms. Are there any symptoms that would be seen in one and not the other?
In other words, what should I specifically be looking for to narrow the field of what we are looking for? I am mostly afraid of misdiagnosis and treatments for the wrong disorders.
His main symptoms are excess energy, anger management type issues (wants to "payback" other children especially for making him angry), unwillingness to cooperate in chores(etc.).
Hi Andy's mom
This is an extremely difficult question to answer. Understand that the actual criteria that currently exist for making these diagnoses are flawed, and most professionals are not trained to do this effectively. This is why you worry about misdiagnosis. If you want to know the specific criteria for each diagnosis, you can look up DSM criteria for ADHD, ODD and Bipolar Disorder.
I can talk with you about ADHD, ODD, and Bipolar Disorder. PDD is not my area of expertise.
Bipolar Disorder is a mood disorder that until the late '90s was not thought to exist in children. We now know that it does exist in children,( although people will argue that it doesn't) and that it evolves and changes into a different looking illness over time. Bipolar Disorder in children does not look like Bipolar Disorder in adults.
To diagnose Bipolar Disorder in a child, the current wisdom holds that they must exhibit distinct signs of mania, and signs of depression, both of which can be found detailed on my website. Many symptoms are associated with the two mood states mania and depression: irritability, anger, anxiety, energy fluctuation, and sleep disturbances to name a few.
Oppositional Defiant Disorder -like symptoms are often seen in a child with bipolar disorder, but they are part of the bipolar disorder, not a separate diagnosis.
Bipolar children can have symptoms of oppositional behavior mostly during mood states, this does not make them ODD. To say this simply, a child with bipolar only exhibits oppositional behavior at certain times( i.e. when they are manic) , whereas a child with ODD always exhibits these behaviors. These behaviors are negative and hostile and consist of arguing, refusing to comply, blaming others, or behaving in a spiteful, angry, vindictive way.
Children who only have ODD behave in a negative and hostile way, but don't have the fluctuation in their symptoms that kids with bipolar have. These children also don’t have all the other symptoms of bipolar disorder.
Children who have ADHD, who do not have bipolar, do not exhibit swings between depression and mania. They exhibit problems with their attention and impulsivity. Children who have bipolar disorder but not ADHD may exhibit disruption in their attention and impulsivity when in certain mood states. Many children with bipolar disorder also have ADHD.
Children can have all of these diagnoses, or any combination thereof. See how complicated this is?
The symptoms need to be studied in the context of a carefully constructed developmental history to get the most accurate diagnosis.
Family history is extremely important during this process. If there is bipolar disorder in the family, this is something I would be looking for as a possibility.
Misdiagnosis can be catastrophic because ADHD medications make bipolar children worse, and perhaps permanently worse. It is also a problem if you are treating a child with bipolar as if they have ODD, because treatment for a bipolar child consists of determining their mood states and modifying their environment based on that. ODD treatment is more behaviorally based, and will be unsuccessful with a Bipolar child.
I hope this has been helpful for you.
WHAT IS MY CHILD"S DIAGNOSIS?
My child is in DHS state custody for his behavior which they are faulting me for so anything I mention is underlooked or not taken seriously.
Yesterday his caseworker paid me a visit with some information on attachment disorders and reactive attachment disorder. I have read the material and am very upset that they would consider this being his problem because none of the causes behind this is even remotely close to my parenting in any of my children and out of 4 he is the one that has the very disruptive concerning needs professional /help problems.
Since he was 3 he was diagnosed with disruptive behavior disorder and treated with Clonidine effective to an extent he got sleep other than that his behavior worsened daily then he was diagnosed under the same medical facility different Dr with ADHD treated with Adderall his condition bettered for about 2 weeks and then he became more violent and uncontrollable. Recently he was hospitalized for injuring another foster child only for him to be released with the diagnosis of ADHD treated with Respiridal a medicine I have been on and know its purposes and what it is used on normally bipolar and schizophrenia and occasionally I have heard of adolescents with post-traumatic stress syndrome.
So my question is this how they all linked to each other than through autism this is something that keeps showing itself in all the research I have done.
I do not believe that my child suffers from the attachment and reactive attachment disorders they have placed in front of me. My patience is wearing thin I am growing fearful of my other child's safety around him as well as my own as he is very violent for no reason not affectionate unless he wants to be which is a rarity.
Both his father and I have bipolar disorder myself is bipolar 1 psychotic disorder personality disorder adhd/ ocd, insomnia, anxiety, and panic disorder. All probable cause of the attachment thing to be not an underlying issue with my son at all I am no medical expert but have stayed up for days on in researching for my son so that I may attempt again over numerous attempts to get him the right type of help and medication he needs. I am in desperate need of guidance and help as it is not being given to me here where I live I am having to go outside the box and I will not stop till someone hears my plea my cry for helping my little boy and his right to live as normally as possible and I know enough to know that if these disorders are caught early enough they can be reversed but not cured please help
You are right to question what is happening with your child. And I am sorry because I have 1000’s of these inquiries to answer and at some point, I stopped answering them and am years behind.
Bipolar disorder is highly heritable. I have to tell you that I would be looking very strongly at that as one of his issues. It doesn’t mean that he doesn’t also have attachment issues. It’s hard to know exactly what’s going on with all of the information you have given me. I can tell you that bipolar is genetic and is exacerbated by stress in the environment, and RAD is generally caused by neglect, abuse, or abandonment. RAD behaviors are more controlled and controlling. These children lack empathy are violent, lack of remorse, and are revenge oriented. Medication for RAD, usually an antidepressant or clonadine, can help with hyper vigilance but not the main behaviors exhibited. Children with bipolar disorder will often achieve mood stabilization with medication. Their behavior isn’t as controlled and fluctuates depending on their mood state. They can show some similar behaviors as kids with RAD, but periodically they desire connection and closeness and will want to please. Risperdal is a medication used for bipolar. ADHD, on the other hand, responds very well to stimulants and sometimes antidepressants. ADHD kids are impulsive and lack attention and focus. They may have low self-esteem and may lie and blame to avoid consequences. They want to please and connect, however, and are generally friendly. These three disorders can overlap. You can have a child that has all three but you need a very good diagnostician to tease out when all these symptoms occurred. I am sorry you are having such difficulty with your child. I hope you have been able to find some direction.
How these illnesses are all related, is another, good question. Just recently a study found autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder and schizophrenia share genetic markers. That’s all we know right now. I hope this has been somewhat helpful.
ADHD AND BIPOLAR
My daughter is very hyper over-talkative and has tantrum fits when something frustrates her. She goes all day talking and repeating things. Like if she can’t get her shirt on she will throw a tantrum or if she is mad at her sister she will throw a tantrum. She can’t do one thing at a time, she will not complete one thing in one sitting. She also will not sit still for a period she is always moving around she does not pay attention well.
For a diagnosis of bipolar to be made, there must exist symptoms of mood fluctuation( mania and depression). Also, a very thorough history needs to be conducted before making this diagnosis.
Similarly, other issues may explain your daughter’s ADHD like behavior. It is also significant to consider how old your daughter is and how long the symptoms have been occurring. For example, if she is six, and these behaviors just started, or in utero, she was exposed to drugs or later had a head injury the diagnosis would be different. I would strongly recommend you take her to a psychologist or therapist for an evaluation.
I hope this helps!
STRATTERA FOR BIPOLAR DISORDER
Does Strattera help a Bipolar child.? My son is 10 and is undiagnosed. His dad and dad's side of the family has Bipolar disorder. I am positive my son has Bipolar disorder.
Thank you, Beth
STRATTERA® (atomoxetine HCl)is prescribed for children with ADHD. It is a selective norepinephrine reuptake inhibitor, with a mechanism of action that is similar to many antidepressants. It is a nonstimulant drug. Doctors will sometimes prescribe stimulants and non stimulants for adhd symptoms if a child's mood is stable, meaning that their bipolar disorder is medicated with mood stabilizers. In this case, doctors in my area will slowly add one of these medicines and monitor the child carefully for any adverse side effects.
If your child has ADHD symptoms, but a stable mood your doctor may prescribe Straterra, however in checking the Eli Lilly website you can see that it may trigger suicidal ideation and manic symptoms. If I were you, I would print out those warnings and bring it to your doctor if you are uncomfortable with the recommendation.
Sincerely, Kristen McClure
ADHD VS. BIPOLAR
Hello, I am 18 years old and going to college. Within the last month a doctor, a neurologist, (who has only known me only during the time I speak of) has put me on Vyvanse for ADHD and Remeron for sleep/appetite.
In the first week of medication, I was very energetic and productive and the Remeron helped me sleep. The second week I did nothing but lay around very depressed and slept a lot. In the third and fourth week, I have not been able to sleep very well at all and have been obsessively working on music (7-10 hours a day).
While on these medications my thoughts feel cluttered like they are tripping over each other and have been more agitated. Towards the end of the day, I have problems with memory also.
I've always been a jittery, scattered minded person with spouts of extreme energy and have had many "episodes", varying in length, of deep depression over the years. On a day to day basis, my moods change on a dime and I have bursts of rage over insignificant things and I've had some minor tics (flaring nostrils and clenching jaw). I've always liked smoking weed to help "slow me down", increase my appetite, sleep well, put me in a good mood, etc. But, I can't live as a "criminal" forever without major consequences; hence me going to a neurologist.
I told the doctor all this but he seems to stay convinced that I am ADHD, so he put me on Concerta and Seroquel (which I have yet to start). I'm not arrogant enough to conclude myself, but I do have my doubts.
What do you think?
I realize this is late. I apologize for the oversight. I wonder what has happened over the past few months. I don't think its arrogant at all for you to have doubts about the medication and the diagnosis. I think it would be important to know what your family history is. If you have a history of bipolar disorder this is significant. I think your experience, however, on the medication is the most important. In no is arrogant to try and determine what might be happening with you. I would continue to do research and keep careful track of the medications that you have been prescribed and the specific reactions you had. Good luck to you and please update us on your progress.
ADHD BIPOLAR QUESTION
Hi, our 5-year-old daughter has been through a lot. She was first to dx ASD but overcame that dx, but was later given a dx of mood disorder/anxiety disorder. She has been aggressive, angry, easily frustrated, OCD, and had MASSIVE tantrums....and has sensory issues....in the past. When I say massive tantrums/aggressive I mean that she has been known to ATTACK checkers at stores, and scream mean things at waiters/waitresses or throw kicking/hitting out of control fits in stores, etc. One pdoc put her on Celexa for anxiety and well, things got bad, REALLY bad. At the worst, she threatened to KILL a kid at school and was drawing pictures of kids, herself, us, etc. with "X-s" on our eyes like we were dead! We were beside ourselves with grief and fear.
At any rate, we weaned off the Celexa and it got a bit better, but after adding Depakote sprinkles things seemed to get much better within a week. She has now been on Depakote for 2 months and we are scared to hope that she will stay the way she is right now. She is doing INCREDIBLE --She is SO GREAT to be with - we are ENJOYING her company and so are her teachers and other kids!! She has less anger, fewer mood swings, less general trauma, more great conversation, more helping, more learning, more sharing, better socializing with kids, etc....BUT SHE IS NOW VERY HYPER.
It is "happy hyper" but man, she has times in the day where we are overwhelmed with her hyperactivity. She is very hyper at school a lot of the time, always at her therapist's, her psychiatrist, and at her regular doc appointments. She is hyper and moving all of the time....interrupting, sassy, very much oppositional, dancing, talking, moving, etc....never stopping and lost in space with following directions, etc.
So, here is the? What is the best ADHD med for a kid that is probably bi-polar? We would like to try Strattera because she has anxiety, but we are scared after the trauma with Celexa. Will the Depakote help with mania? Thanks! Angie
As you know I am not a doctor and am not allowed to give out medical advice, however, I can tell you that if I haven’t misunderstood you, I would consider that you might be seeing some form of mania and not ADHD. Kids with ADHD are more consistently hyper and probably wouldn’t suddenly get hyper.
I can tell you that doctors will sometimes try Straterra because it is considered a non-stimulant medication. It is not the same as Celexa.
If your child does have ADHD, which I would be sure of first, It would be important that you are certain her mood is stabilized before trying to medicate the ADHD. When children with bipolar have ADHD, and their mood is stable, the doctors that I work with follow the rule of beginning with a low dose and increasing it very slowly to ensure that there are no side effects
Good luck with your child!!!
(st. peters mo, usa)
I have twin daughters, one is passive and the other is aggressive. As of tonight, I took them both off Ritalin and picked up some vitamin B,C and omega 3 supplements; chamomile tea and lavender.
I do not want to use medication to stabilize moods, but the aggressive child has been written up three times at school for hitting? I am a single mom and I keep a consistent routine. I a starting them with swimming and gymnastics to give them something to earn and be rewarded with.
I have insurance if you are located in the St. Louis area and are accepting new patients.
I'm not in your area, unfortunately. I can certainly understand your desire not to have your children on Ritalin. Ritalin is not considered a mood stabilizer. It is most frequently prescribed for ADD/ADHD. I wonder if the child you describe as aggressive has impulse control problems? There are methods to teach children impulse control and you may be able to contact a local therapist in your area who specializes in behavioral disorders or ADHD who can help with that? It may be that the school counselor is aware of someone who specializes in that area. It may also be that by exploring some of the sites that specialize in ADHD, you can buy some products and work with your child at home on impulse control.
I'm not sure of the extent of your child's issues or what psychological assessments or therapy has been tried. Some children certainly require medication to improve their quality of life.
I wish you luck in managing your child's behaviors without medication!
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