Ask the Experts

Is it ADHD or Bipolar Disorder?

ADHD and bipolar disorder often look alike at first. Know what symptoms and behaviors to look for.

ADHD or Bipolar - Diagnosing Children
ADHD or Bipolar - Diagnosing Children

Children and adolescents with attention deficit disorder (ADHD) exhibit behaviors similar to those of Bipolar Disorder (BPD) – so making the correct diagnosis is often difficult, but critically important.

Diagnosis dictates treatment, and the wrong medication can actually worsen symptoms of these conditions. Complicating matters further is the fact that about half the children who have BPD may also have ADHD, which means clinicians often have to determine whether both problems exist.

It’s a difficult call because the disorders often look alike, although for different underlying reasons. Children and adolescents with ADHD may be physically active, if not very active. They may be inattentive because of their distractibility and appear to have difficulty staying with any one thought or task. Impulsivity may lead to inappropriate behavior and quick displays of anger. The same symptoms often hold true for children and adolescents with BPD.

In a “hypomanic” or “manic” state or mood, bipolar children and adolescents may be just as physically active as those with ADHD. They might also be inattentive in this state because their minds are racing from thought to thought. A depressed mood may make them inattentive and, like those with ADHD, BPD youth may act inappropriately or show anger quickly. The difference is that their anger is driven by mood, not impulse.

Making the diagnosis involves figuring out what drives the behavior. Clinicians do this by both observing the behaviors and obtaining a history of their onset and pattern.

Observing the child’s behaviors

The child or adolescent with ADHD has it all the time. They will show one or more of three chronic, or ever-present behaviors: hyperactivity, impulsivity, and/or inattention/distractibility in most situations.

By contrast, BPD is characterized by cycles of mood states, rather than by consistent behaviors. The BPD individual may move back and forth between being sad or depressed to normal mood to euphoria and what is called a hypomanic or manic state.

When manic, they may describe their thoughts as “racing.” They feel “wired,” not just active, and often are unable to relax, slow down, eat, or sleep for hours or days. Their mood may swing from affability to extreme rage, often with explosively angry reactions. These mood swings might repeat several times – as many as 20 or more times a day. Without warning, the child might become sad, then very happy or amiable, and then enraged so quickly that observers are left scratching their heads.

Obtaining a history of the behaviors and their pattern: ADHD is present at birth, and is chronic and pervasive in nature. Parents will often describe their child’s hyperactivity, inattention, and/or impulsivity as having been evident since early childhood, as having been a problem during each year of life, and as showing up at school, home, activities, and with peers.

BPD is different. Its onset usually is later (between ages eight and twelve) and the behaviors are more cyclic than chronic; that is, they are not consistently present and rarely are they present in all situations.

Obtaining a reliable family history also can help determine the diagnosis; both disorders have a strong genetic component. In any event, it takes a competent, well-trained child and adolescent mental health professional to make this complicated call.

Since medication will likely be needed for either condition, a medical doctor should be involved in confirming the diagnosis and developing a treatment plan. Targeted psychotherapies are helpful for both disorders, and should be administered by a physician or other mental health professional who specializes in treating these conditions.