Does My Child Have ADHD or Bipolar Disorder?

Like children with ADHD, bipolar children can exhibit symptoms of inattention, overactivity, and impulsivity. But unlike kids with ADHD, they tend to show these symptoms, or a change in their intensity, specifically when their mood is unstable. ADHD is the disorder that most often co-occurs and is confused with Bipolar Disorder. About 11 to 22 percent of children and adolescents diagnosed with ADHD also meet the criteria for Bipolar Disorder.¹ More over, studies indicate that anywhere from 57 to as high as 98 percent of children diagnosed with pediatric mania, that is, the manic episode in Bipolar Disorder (which can be marked by inattentiveness, overactivity, and impulsivity), also meet the criteria for ADHD.² You can see the way in which the overlap in symptoms can make it quite challenging for a clinician to determine whether your child is suffering from ADHD or Bipolar Disorder. To tease out the differences, let's look more closely at the symptoms.

How Mood Plays a Role

First, here's how inattention, overactivity, and impulsivity might look in a child with Bipolar Disorder:

• Inattention (this can be seen in either the elevated or depressed mood state)
  
  In bipolar depression: The depressed bipolar child's mind seems to work more slowly than normal or his thinking is foggier. That's why he has a hard time concentrating.
  In bipolar mania: The manic bipolar child often has a hard time paying attention because his thoughts are moving too fast and are too hard to hold onto. He also is easily distracted.
• Overactivity (this can be seen in both extreme mood states but is more likely to occur in mania)
In bipolar depression: Some children and adolescents have what is called an "agitated depression." These children often appear uncomfortable in their own skins and quite restless and agitated in the depressed state.
In bipolar mania: Like the ADHD child, a youngster in a hypomanic or manic state can have a hard time sitting still, since he is "wired," full of extra energy, and ready to go!
• Impulsivity
In bipolar depression: This symptom can occur on occasion but is much more typical in the hypomanic or manic state than in the depressed phase.
In bipolar mania: The bipolar child with an elevated mood can be outrageous in his decision making and choose dangerous activities, such as deciding to give himself a haircut with scissors or climbing a tree without any thought that it might be difficult to get down. He also may be sexually inappropriate (for instance, telling his babysitter he likes her "boobies").

It must be stressed again that all psychiatric and general medical symptoms and disorders vary from child to child and often from setting to setting. Thus, children who are overactive, impulsive, and/or inattentive will typically—regardless of their diagnoses, whether ADHD or Bipolar Disorder—exhibit these symptoms to different degrees in different settings. Some may look as though they are bouncing off the wall (literally). Others sit in their seats but play with everything on their desks or sit on their hands to prevent themselves from getting into trouble (in other words, they've learned some tricks to compensate for their problem). Some make dangerous or foolish decisions, such as setting off the school fire alarm on a whim, and others will call out answers in class rather than wait for their turn.

You may think that your child seems to be able to pay attention quite well when she's doing something she really likes. Keep in mind, though, that it's not that children with the diagnosis of ADHD can never focus; what they are doing has to be interesting enough and reinforcing enough to keep their attention. For most children, it is easier to focus on a video game than on their homework because the game is infinitely more interesting, with immediate and constant gratification.

Next: Similarities and differences >>

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