Diagnosing Bipolar Disorder in Children with ADHD

Is bipolar disorder more common in children with ADHD? Find out how the right diagnosis can improve treatment for your child with ADD.

Five ways to soothe your worried ADHD child. ADDitude Magazine

Many children will be both manic and depressed at the same time.

Barbara Geller, MD

Until recently, it was believed that bipolar disorder only occurred in adults. But doctors are now finding that children as young as seven years old can have the disorder. New research about bipolar disorder in children was presented at the Fourth International Conference on Bipolar Disorder in Pittsburgh, Pennsylvania.

The study, which was supported by grants from the National Institutes of Health, also looked at the differences between children with attention deficit disorder (ADD ADHD) and those with bipolar disorder.

"We want to distinguish between children with bipolar disorder and ADHD because many parents, teachers and health care providers might confuse the overlapping symptoms of the two problems and think that these are just hyperactive kids," said Barbara Geller, MD, a professor of child psychiatry at Washington University School of Medicine in St. Louis,Missouri. Geller was the principal investigator of the study.

Geller told her audience that bipolar disorder in young children resembles the worst form of the illness in adults.

Adults with bipolar disorder have episodes of either mania or depression that usually last a few months. During these episodes, the bipolar adult experiences severe changes in mood - either becoming extremely irritable or overly silly, increased energy, disregard of risk and other symptoms.

In the study presented in Pittsburgh, Geller wanted to establish how bipolar behaviors like mania, grandiosity, and mood swings would appear in children. "In this study, we have investigated children who have repeatedly called the principal or other officials at school to tell them to fire a teacher or do something else to make the school run more effectively in the eyes of that child." These behaviors go beyond normal student complaints about teachers. Bipolar children would act as if they were in charge of the principal's office.

Geller's group found that the children involved in her study had a more severe, chronic course of illness than the typical bipolar adult. "Many children will be both manic and depressed at the same time, will often stay ill for years without intervening well periods, and will frequently have multiple daily cycles of highs and lows."

Larry Silver, M.D. of Georgetown University Medical School emphasizes that a correct diagnosis is critically important. In the September/October issue of ADDitude Magazine, Dr. Silver wrote that the wrong medication can actually worsen symptoms of these conditions.

Comorbidity, or the existence of two or more disorders at the same time, is also a consideration.

"Complicating matters further is the fact that about half the children who have bipolar disorder may also have ADHD, which means clinicians often have to determine whether both problems exist," wrote Dr. Silver.

Doctors disagree on treating children who have ADHD and bipolar disorder with psychostimulants like Ritalin.

NIMH warns that "There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat attention deficit hyperactivity disorder (ADHD) or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms." (See Child and Adolescent Bipolar Disorder:An Update from the National Institute of Mental Health .

However, other researchers, like Peter Jensen, M.D., of Columbia University/New York State Psychiatric Institute in New York City, believe that the treatment of children who have symptoms of bipolar disorder and ADHD should include stimulants and, where warranted, mood stabilizers. These comments were made when Jensen was speaking at the 153rd Annual Meeting of the American Psychiatric Association (May, 2000). (More information is available at Medscape.com. The Medscape web site requires registration.

The National Institute of Mental Health (NIMH) recommends that children or adolescents who appear to be depressed and exhibit ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, be evaluated by a psychiatrist or psychologist with experience in bipolar disorder. This is especially important if there is a family history of the illness, as bipolar disorder, like AD/HD, tends to run in families.

More information about ADHD and bipolar disorder in children is available online in a Fact Sheet from NIMH . (Note: Links to pages that are not on the ADDitudemag web site will open a new browser window. Close the new window to return to ADDitudemag.com)

 

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