Bipolar and Adhd

Currently we don’t quite understand the relationship between bipolar disorder and adhd.

Many adults and children initially diagnosed with adhd , later go on to be diagnosed with bipolar disorder. What does this mean? In some cases they may have been misdiagnosed initially with adhd when they actually had bipolar disorder. Or perhaps it means that these people have both both bipolar and adhd . Do the symptoms of adhd somehow evolve into bipolar disorder? All of the diagnostic overlap is causing many to question whether we need to reevaluate the way we think about these illnesses. For purposes of this page, I will highlight the things you need to know about the treatment and differences between adhd and bipolar disorder. Hopefully then you can have some guidelines to understand is it adhd or bipolar.

If you are looking for more information on ADHD Click here.

In my experience children often have both bipolar and adhd. Other children I work with have bipolar disorder without adhd but have been misdiagnosed as having adhd. When those children were properly medicated for their bipolar disorder, their symptoms of adhd went away.

What do we know about the relationship between bipolar and adhd in kids?

We know that bipolar and adhd have overlapping symptoms.

For example both disorders include symptoms of :

Distractibility

Restlessness

Over talkativeness

Stimulants and antidepressants can be harmful for bipolar kids

My caseload is filled with children who were harmed by being medicated for adhd when they had a mood disorder. Children with BPD 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.

The general rule is the mood is stabilized first before adding any adhd medicine

Children with bipolar disorder and adhd should first have their mood stabilized prior to a stimulant or antidepressant being added. If these medicines are added, they are normally started at a low dose and slowly raised, with careful attention to side effects.

A separate diagnosis of adhd is difficult to make in a bipolar child unless they are stable

Unless a child has responded to 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 distractibility, restlessness and fluctuations in attention and concentration that vary with mood states. Sometimes when the child is stable these symptoms go away.

Mania does look distinctly different than adhd, but you have to know what you are looking for.

Below are some key differences:

Children who have bipolar disorder may become suicidal, hypersexual and may have psychosis. Children with adhd normally do not have these symptoms.

Children with BPD will at times become aggressive, violent, and have protracted tantrums because schoolwork or something is frustrating them. Children who have adhd may become frustrated and struggle with their school work but not to this extent.

Children who have adhd do not exhibit grandiosity the same way children with mania do. Children with mania believe that they can do things they cannot. They may believe they are faster and stronger than superman or that they know more than the teacher.

Children who are manic have a decreased need for sleep during manic periods, so there is a distinct change in the child’s normal sleep patterns, and they do not appear tired. Children who have adhd have more constant sleep patterns.

ADHD symptoms are constant, bipolar symptoms vary with mood state. For example, an adhd child might always have rapid speech, but a child with bipolar disorder will only have rapid speech when they are manic or hypo manic.

What can you do if you are a parent to advocate for your child who may have adhd and bipolar disorder?

1. Make sure to tell the Dr. if you have a history of BPD or alcoholism in your family especially if your psychiatrist or pediatrician believes your child has adhd .

2. If you believe your child has been depressed, or you notice they have mood swings make sure to tell a Doctor who is considering a diagnosis of ADHD.

3. If you suspect for any reason your child has bipolar disorder, and someone has given them an adhd diagnosis get a second opinion prior to allowing someone to put your child on a stimulant or antidepressant

4. If your child is diagnosed with bipolar and adhd, and your child is not stable remember to question the Doctor as to how they arrived at the adhd diagnosis.

5. If your Doctor does not believe in childhood bipolar, get a new doctor.

Click here for more information about TDDD a new diagnostic category proposed for children with mood dysregulation.

Click here for more information about bipolar disorder and memory loss.

If you have questions or comments or would like to contact me to set up an appointment click here .

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