ADHD and Bipolar Disorder

“Last year my 11 year old son was diagnosed with ADHD. Now his doctor thinks that he is bipolar. What happened? How and why did my son become bipolar? Will he stay bipolar when he grows up? Did he become bipolar because of the ADHD?”

I commend you for your awareness of your son’s behavior patterns and your decision to seek professional involvement. First I wish to mention a few studies that relate to your questions.

Kent and Craddock (Journal of Affective Disorders, February 2003) examine the growing attention to relationships between bipolar disorder (BP) and ADHD. Their literature review suggests that although there is support for possible relationships between some ADHD and manic-like symptoms, diagnostic categories of BP and ADHD appear to be unrelated.

Galanter and Leibenluft (Journal of Child and Adolescent Psychiatry, April 2008) also provide a current review of the literature examining associations between ADHD and BP. Important inclusions in their review are family and genetic studies and physiological comparisons for those with ADHD and irritability in comparison to those with BP.

According to Geller, et al. (Journal of Affective Disorder, November 1998), the main differential diagnosis of early adolescent BP is attention-deficit disorder with hyperactivity (ADHD). They found that the mean baseline age of diagnosis for BP was 11 years, +/-2.7, and that the mean age of onset was 8 years, +/-3.5. So in terms of age, your son is in the projected range of dual diagnosis. However, elevated mood, grandiosity, hyper-sexuality, decreased need for sleep, racing thoughts, and all other mania signs except hyper-energetic and distractibility were significantly and substantially more frequent among Bipolar that ADHD cases. Does your son have feelings of elation or grandiosity? What are his sleep patterns and/or level of anxiety? Does he have feelings of suicidality with plan/intent or rapid, ultra-rapid or ultradian cycling? These are some of the mania-specific symptoms that differentiate early adolescent bipolar cases from ADHD.

From my own professional perspective as a licensed clinical psychologist, other relevant aspects of diagnosis concern family history and the psychosocial characteristics of your family. The family and its system are important components in the development of symptomatic behavior and some outward signs of mental illness. An examination of family development can lend insight into current symptomatic behavior. Another aspect of a number of cases is that a particular family member is viewed as the “identified patient.” I would recommend one or two sessions in family therapy to identify the systemic makeup of your family and assess its impact on your son and his behavior.

It is impossible for me to determine how your son became bipolar or the extent to which ADHD “caused” BP. Rather, I would examine the history and present functioning of the family, the physiological and genetic traits of your son, his medical history, including any injuries, diseases and past medications, and detailed differential diagnostic testing. Often it is several years between initial diagnosis and appropriate treatment. It is imperative that you lose little time in finding a well-trained psychiatrist familiar with current professional literature and able to adequately differentiate the alternative diagnoses in your son’s case. Whether ADHD or BP, various psychotherapy approaches have helped alleviate symptomatic behavior. Cognitive-behavior therapy in particular has proven effective. I encourage you to consider psychotherapy as a part of your son’s treatment regimen.

With ADHD, your son may be symptomatic for the rest of his life, but can be stabilized with proper medication and treatment. If, it is true that your son also has BP, he will also have symptoms associated with this disease for the rest of his life. But with proper treatment, he can remain stable and live a fulfilling and productive life.

As I always suggest, if you have not already done so, I encourage you to contact The National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA) about their programs for persons suffering from mood disorders and their families and friends. Involvement with groups such as these can provide much support and help you through these difficult times. It is particularly important to realize that you are not alone.

Dr. Manuel S. Silverman, PhD