ADHD and Bipolar Disorder

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Differentiating between ADHD and Bipolar Disorder is difficult and highly challening but important.

Currently we don’t quite understand the relationship between ADHD and Bipolar Disorder.

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. Also scroll, down to read some Q and A about ADHD and Bipolar.

In my experience bipolar 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 and why is it so hard to tell the difference between these two disorders?

Click to learn about adult adhd and it's definition

Click here to learn about adult adhd and procrastination


ADHD and Bipolar can have overlapping symptoms

For example both disorders include symptoms of :

  • Distractibility
  • Restlessness
  • Over talkativeness
  • Loss of social inhibition
  • Impulsiveness

As you know if you have been reading these pages, there is no specific category for Bipolar Disorder in Children. It is a challenging diagnosis to make.  Children who have mania may have fairly distinct features of elation and grandiosity but children who have bipolar disorder are not always manic. Children who are manic may also exhibit the above signs which can easily be confused with ADHD. 

Medicine in children with ADHD and Bipolar is complicated

If a doctor makes the wrong diagnosis of ADHD when a child has bipolar disorder it can really mess a kid up. If a doctor diagnosis an ADHD child with bipolar disorder, it can really mess a kid up. 

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 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!

What if a child has both? The general rule is the mood is stabilized first before adding any adhd medicine

Children with cooccurring adhd and bipolar 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 dis tractability, restlessness and fluctuations in attention and concentration that vary with mood states. Sometimes when the child is stable these symptoms go away.


How do you distinguish between Bipolar  and ADHD?

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 Bipolar Disorder 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 that they become regularly violent and tantrum for hours.

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.

Ho to advocate for you child if they have ADHD and Bipolar Disorder

  • 1. Make sure to tell the Dr. if you have a history of Bipolar Disorder 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 ADHD and Bipolar, 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

Questions sent in about Bipolar and ADHD




ADHD WITH (NON-SPECIFIC) MOOD DISORDER

by EL

(Dearborn Hts. MI (USA))

My son is 13 and recently diagnosed with mood disorder. He has been diagnosed with ADHD since he was 3. Currently, still having to take meds for that, and now 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 the following questions.

 

  1. Does one trigger the other?
  2. What parts of the brain does it affect?
  3. Are the two possibly related?
  4. Can the medication that he was taking (stratera and concerta)at the time prior to being diagnosed influence the mood swings?
  5. Are they hereditary 
  6. Are there some behavior modification suggestions?
  7. Do you find that these disorders are common among some social classes more than others?

Hi Eva

Answers

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 alot 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? 

I'm not well versed enough to speak to the difference in the areas of the brain that are effected by each of these disorders. Attention, concentration, cause and effect thinking, and impulse control are the areas that are impacted in both disorders. Executive functioning is impaired.

Are the two possibly related? Yes. See this link

http://www.bipolarchild.com/Newsletters/9911.html

 

Can the medication that he was taking (stratera and concerta)at the time prior to being diagnosed influence the mood swings?

We believe it is possible that these medications 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. 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 

SYMPTOMS

by Andy's mom 

(Minnesota)

We are in the process of having our child (7 years) evaluated for various disorders. He was just tested positive for 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 cross 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 "pay back" other children especially for making him angry) , unwillingness to cooperate in chores(etc.). 

Answer

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 90's 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.

In order to diagnosis 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. There are many symptoms that 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 diagnosis, or any combination therof. See how complicated this is? 

The symptoms need to be studied in the context of a carefully constructed developmental history in order 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.

Sincerely

Kristen McClure




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 under looked or not taken seriously.

Yesterday his case worker 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 with 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 mine own as he is very violent for no reasons not affectionate unless he wants to be which is a rarity. 

Both his father and myself 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 doing research 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

Thank you 

ANSWER

Hi 

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. 

Sincerely. 

Kristen McClure




ADHD AND BIPOLAR

My daughter is very hyper over talkative and has tantrum fits when something frustrates her. She goes 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 of time she is always moving around she does not pay attention well.

 ANSWER

Hi Mary

In order 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 prior to 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 expose 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 and evaluation.

I hope this helps!

Kristen




STRATTERA FOR BIPOLAR DISORDER

Question

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

ANSWER

Hi 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 there bipolar disorder is medicated with mood stabilizers. In this case doctors in my area will slowly added 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

(Michigan)

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. 

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. 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 cant 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 come to a conclusion myself, but I do have my doubts.

What do you think?

ANSWER

Dear Michegan

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

by Angela 

(Oregon)

Hi, our 5 year old daughter has been through a lot. She was first 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 actually are ENJOYING her company and so are her teachers and other kids!! She has less anger, less 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 totally 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

ANSWER

Hi 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 canell 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 prior to 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!!!




RITALIN

by sarah

(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.

Kind Regards,

Sarah

ANSWER

Hi Sarah:

I'm not in your area, unfortunately. I can certain understand your desire not to have your children on Ritalin. Ritalin is actually 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!

Sincerely,

Kristen McClure

  • Bipolar in Teens
  • Childhood Bipolar
  • Alternative Treatments for Bipolar
  • Parenting and Bipolar
  • Bipolar and School
  • Bipolar and Memory
  • Therapy for Bipolar
  • Alcoholism and Bipolar Disorder
  • Bipolar and Creativity
  • Stages of grief for parents of children with bipolar disorder
  • Medications for bipolar children
  • Support groups for parents
  • Lithium for children
  • Seroquel for children
  • Stages of anger of the illness in in children and how to parent through them
  • Stories about bipolar teens
  • Bipolar ad self injury
  • Is it bipolar or autism?
  • Is it bipolar or adhd?
  • Thanks for visiting! Feel free to email me at kristenlynnmcclure@gmail.com

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