Attention Deficit Hyperactivity Disorder and Bipolar Disorder: Diagnosis, Treatments, and Clinical Considerations: A Narrative Review

Abstract

Attention-deficit Hyperactivity Disorder is one of the most common childhood mental health disorders, affecting about 5.6% of the population worldwide. Several studies have specifically shown a high prevalence of comorbid mood disorders, such as depression and bipolar disorder (BD), in those diagnosed with ADHD. Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances. The inattention and impulsivity of ADHD can be seen in manic and hypomanic episodes of BD. Over the past decade, there has been an increased interest in research between the correlation of ADHD and pediatric bipolar disorder (PBD) in children. Some experts hypothesize that more children are comorbidly diagnosed with ADHD and PBD because of how many clinicians treat children with ADHD. Other factors, which may affect the dual diagnoses of ADHD and PBD, are overlapping diagnostic criteria for the two disorders, the inevitable biases seen when one disorder is diagnosed without the other, and related risk factors leading to prodromal relationships. By examining clinical trials, a better understanding of whether ADHD and PBD have a stepwise progression or if other factors influence these comorbidities, such as blurred lines of diagnostic criteria. Those with ADHD are also at an increased risk of impairment at work and in social settings. This manuscript explores both progression of this disease and its clinical connections to other disorders.

Differentiation and comorbidity of bipolar disorder and attention deficit and hyperactivity disorder in children, adolescents, and adults: A clinical and nosological perspective

“…ADHD is a common childhood mental health disorder, even if its prevalence varies widely across different clinical settings and countries, partly due to differences in classifications and methods to diagnose it ( 9 ). About 50–65% of children with ADHD will continue to meet diagnostic criteria for ADHD in adulthood ( 4 , 10 ).…”

“…There is an overlap between symptoms of ADHD and BD, and in particular (hypo) manic mood episodes features, such as hyperactivity, distractibility, lack of inhibition, restlessness, racing thoughts, rapid speech, talkativeness, and irritability. The overlap of symptoms and diagnostic criteria could make the distinction between the two disorders difficult, even if ADHD is a disorder with persistent symptoms, whereas symptoms in BD are episodic ( 4 , 11 , 12 ).…”

“…Many children are diagnosed with comorbid ADHD and PBD; comorbidity rates are estimated to be around 20% ( 1 , 4 ), and children with ADHD are more likely to be diagnosed with BD later in life ( 4 ). BD with comorbid ADHD presents a more severe course of illness, with earlier onset, a shorter interval between episodes, and a shorter time of euthymia ( 11 ).…”

“…Bipolar Disorder (BD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are often recognized as mental disorders with a high degree of comorbidity (1)(2)(3)(4). Bipolar disorders are chronic diseases characterized by the alternance of episodes of mania or hypomania and depression.…”