Attention deficit hyperactivity disorder, or ADHD, and bipolar disorder are two diagnoses that are considerably different but may impact children in similar ways. While ADHD is characterized by difficulties with attention, hyperactivity and impulsivity, some of these symptoms are apparent in children with bipolar disorder, who struggle between extreme moods. There is some overlap in diagnosis, with some children having both disorders; however, it is important to tease apart the differences in order to provide accurate diagnosis and treatment.
Symptoms of ADHD
Children with ADHD may demonstrate symptoms of inattention, hyperactivity and/or impulsivity. The three diagnosable types of the disorder are predominantly inattentive type, predominantly hyperactive/impulsive type, and combined type, which includes all of the symptoms. Difficulties with attention include trouble concentrating, appearing distracted and forgetful, losing items, tendency to daydream, lack of focus, disorganization, trouble completing homework or chores, not listening to others, and inability to follow directions. Hyperactive behavior may include trouble sitting still, appearing to be always moving, fidgeting, and rapid talking. Impulsive behavior may include emotional outbursts, acting without thinking, interrupting others, and impatience.
Symptoms of Bipolar Disorder
Children with bipolar disorder demonstrate extreme changes in mood that vary between depression and mania. Symptoms of depression may include feelings of sadness, hopelessness, irritability, complaints of pain, difficulty concentrating, difficulty sleeping, little energy, and thoughts of suicide. Symptoms of mania may include feeling euphoric, overly happy and ecstatic mood, irritability, talking fast, not sleeping, impulsive and dangerous behavior, restlessness, and believing oneself to have special powers or abilities. These two mood states may occur together in some children and are known as a mixed state.
Bipolar Difference from Adults
Symptoms of bipolar disorder manifest somewhat differently in adults than in children. There has been some debate over the use of the same diagnostic criteria because the disorder can look so different in the two populations. When bipolar disorder begins in childhood, it is usually a more extreme form of the disorder. Children with bipolar disorder are more likely to have mixed episodes, meaning they experience depression and mania at the same time. They are also more likely to quickly move between mood states and demonstrate considerable irritability.
Overlapping Symptoms
In diagnosing a child with bipolar disorder or ADHD, symptoms must be closely examined. There is considerable overlap in some of the symptoms. For example, symptoms of mania, including difficulty concentrating, being easily distracted, and hyperactive or impulsive behavior, may appear similar to symptoms seen in a child with ADHD. However, differentiation between the two disorders is possible when closely examined. Children with ADHD do not show the extreme changes in mood that characterize bipolar disorder. Also, ADHD symptoms are often apparent early in childhood, before the age of 7, while symptoms of bipolar disorder are not often noticed until later childhood/early teen years.
Treatment
These two disorders are treated somewhat differently based on the presenting symptoms. ADHD is often treated with a combination of stimulant medication and psychotherapy. Stimulant medications like Ritalin or Adderall, help manage the symptoms of ADHD and allow a child to focus and control his behavior. Behavioral therapy in home or school settings can help a child to learn ways to improve his concentration and control impulses and hyperactivity. The treatment for bipolar disorder also often includes a combination of medication and psychotherapy. Symptoms are usually treated with a mood stabilizer, which helps children manage the extreme mood states. Additional medication, such as an antidepressant, may be prescribed to control symptoms of depression. Psychotherapy can be helpful by providing children with support as well as information on the nature of the disorder and its symptoms, how to manage relationships, and how to manage thoughts and behaviors linked to feelings of mania and depression.
References
- National Resource Center on ADHD: Pediatric Bipolar Disorder
- National Institute of Mental Health: What are common symptoms of bipolar disorder in children and teens?
- National Institute of Mental Health: How does bipolar disorder affect children and teens differently than adults?
- National Institute of Mental Health: What are the symptoms of ADHD in children?
- National Institute of Mental Health: ADHD Medication & Psychotherapy
