Differentiating Between ADHD and Bipolar Disorder in Children

Diagnosing Bipolar disorder in children is not an easy task. Bipolar disorder mimics ADHD in children enough so that some studies in certain samples show almost a 90 percent overlap between the two. In the diagnostic criteria for mania, almost half of the characteristics can be applied to manic episodes and ADHD.

Here is a five-symptom model from Emily I. Fergus, M.D., of the National Institute of Mental Health. The following symptoms, when they occur together, predict bipolar disorder in 91 percent of cases:

  • Grandiosity
  • Suicidal thoughts or gestures
  • Irritability, bullying, outbursts, agitation
  • Decreased attention span, attention deficit
  • Racing thoughts, hyperactivity

Other symptoms include temper tantrums, poor frustration tolerance, impulsivity, increased aggression, lack of remorse, decreased sleep (sleep disorders) and inappropriate sexual behavior.

Common features of bipolar disorder in children: Strong family history of bipolar disorder. Bipolar disorder may be inherited. Estimates range from 30 to 40 percent (when one biological parent is affected) to 50 to 70 percent when both are diagnosed with major affective disorder. Doubt a preliminary diagnosis of bipolar disorder if there is no family history of major affective disorders.

 Discrete episodes of extremely disruptive behavior: Usually, children with ADHD are active most of the time. They do not have long periods of good attention and low activity alternating with severe misbehavior. In other words, their behavior is not cyclical. In contrast, children with bipolar disorder have distinct, sometimes well-defined episodes of extreme disruptiveness. It might last from days to weeks and is usually strikingly different from the baseline, even if the baseline is not that of a model citizen.

Sometimes severe deterioration of behavior falls in winter months, following closely with length of light time, suggesting seasonal affective disorder (SAD). The role of light may be important for some.

Early sexual themes:  A child’s life is filled with milestones to be reached, hurdles to get over, and skills to develop. Sexual maturation has two distinct milestones:

1) the genital period and 2) the sexual period. The first is characterized by interest in private parts and physiological function related to these parts and the other is marked by interest in the opposite sex, sensuality, sexuality, issues of sexual orientation, etc. In between there is a period called 3) latency, when children show little or no interest in these issues and actually become somewhat embarrassed when encountering anything related to the genitals or sex. Some children with bipolar disorder have excessive interest in sexual themes early in life, far before their peers begin to show any awareness of these issues.

Great capacity for eliciting emotional responses in others: Some children with bipolar disorder may have difficulty with peers. Teasing and eliciting a strong emotional response may give children some sort of satisfaction. Perhaps it is the intensity rather than the quality of the interaction that is appealing, because for some it makes little difference whether the encounter is positive or negative.

Intensity of anger: Bipolar children amass an incredible degree of anger. They do not just get angry – they go through rage. This is somewhat different from a typical ADHD child whose anger might be explosive, but lacks the intensity of a child with a bipolar disorder.

Poor response to stimulants: Bipolar disorder is almost invariably first diagnosed as ADHD. Children start on stimulant medications as a way to treat ADHD, and often (but not always) don’t do well.

Poor or too quick a response to antidepressants. Bipolar disorder patients are notoriously poor responders to antidepressant medications, and it often causes them to swing into intensely irritable, aggressive, or hypomanic mood. Also, too quick of an antidepressant response is suggested to be a characteristic of bipolar disorder.

Being a daredevil or risk-taker: A typical ADHD child is impulsive and often gets into trouble for doing something without thinking, with a typical “oops” following the wrong action. They are usually not reckless and tend to feel sorry afterward. Some children with bipolar disorder love the thrill of being a daredevil. They love risk, and will climb to the tallest tree and ski from the highest mountains.

Extremes of emotional lability and irritability of mood: Their irritability may be the earliest symptom. The littlest thing can turn their mood from happy to hideous in a matter of minutes.

Here are some possible risk factors for bipolar conversion in adolescent depression:

  • Young age
  • Acute onset
  • Atypical (hypersomniac) depression
  • Labile, unstable mood
  • Psychotic depression
  • Family history of bipolar disorder
  • Pharmacologically induced manic symptoms

– Author Unknown