Ask the Doctor: Is It ADHD or Bipolar — or Both?
How to get an accurate diagnosis and effective treatment
Reprinted with permission from bp Magazine: www.bphope.com
Attention deficit and hyperactivity disorder (ADHD) and bipolar disorder (BP) have some signs and symptoms in common, including mood instability, bursts of energy and restlessness, talkativeness, and impatience. Such seemingly overlapping features can cause individuals and families to ask, “Is it ADHD or BP — or both?”
An accurate diagnosis is an essential first step in the treatment plan because what is effective for one disorder may be quite the opposite for the other. An individual with long-standing difficulties in the classroom from an early age will benefit enormously from a stimulant medication; however, a person who has been a good student or an engaged worker who suddenly loses his or her ability to focus and expresses irritable moods, with impulsive behaviors, may not benefit from a stimulant medication — indeed, a stimulant might trigger an overt manic episode.
Distinguishing ADHD from BP is challenging. This is best achieved by working with a clinician who is knowledgeable about these two disorders and also familiar with the individual’s medical and behavioral history, as well as academic or vocational record.
What are the signs and symptoms of ADHD?
ADHD is characterized by significantly higher levels of inattention, distractibility, impulsivity, and/or physical restlessness than would be expected in a person of similar age and development. While mood swings may be dramatic, they occur in response to life events; for example, expression of frustration and distress when presented with tasks demanding concentration. For a diagnosis of ADHD, such symptoms must be consistently present and impairing.
ADHD typically begins early in life, before the age of 7. The symptoms of ADHD persist in several aspects of the individual’s life; tasks that require focus and attention at school, at home, and, for older individuals, at work, will all be affected. The core features of ADHD include an inability to concentrate, as well as a pervasive restlessness that may be described as an “inability to sit still” or the “wiggly-squiggly” child in the classroom.
What about BP?
The core features of ADHD overlap with bipolar symptoms: Both depression and manic episodes dilute the ability of the person to focus and concentrate, and irritability can clearly result in a physical restlessness; for example, pacing or attending to many things at once but with little accomplished.
Bipolar disorder is considered to be periodic, and manifests in episodes of depression, mania, or hypomania. A careful review of the medical and behavioral history will suggest that there are periods of time when the individual is well, and other periods when he or she is not. Intense feelings of mania or depression shift for no apparent reason over a period of days to weeks, and may persist for weeks or months. Commonly, there are periods of months to years during which the individual experiences no impairment. While we now recognize that children can develop bipolar disorder, the majority of people who develop BP have their first episode after age 18.
What is the treatment for someone with both ADHD and bipolar?
It is estimated that as many as half of the people diagnosed with ADHD also suffer from a mood disorder on the bipolar spectrum — and correct diagnosis is critical in treating bipolar disorder and ADHD together.
The management of combined BP and ADHD is generally a combined medical and psychological approach and is dependent on accurate observations of family and others close to the individual. Objective assessments of behaviors and moods over time will provide the basis for diagnosis and for evaluation of the effectiveness of the treatment strategies. Both disorders must be systematically, yet cautiously, addressed in treatment.
People with a dual diagnosis of ADHD and bipolar disorder can be treated very effectively. It’s important to always diagnose and treat the BP first, as ADHD treatment may precipitate mania or otherwise worsen BP. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment.
Reprinted with permission from bp Magazine. All rights reserved. For more articles like this one, visit www.bphope.com