by Biser Rangelov
reading time: 3 min
ADHD and Childhood Bipolar Disorder
Children misdiagnosed with bipolar disorder typically have serious difficulties that resemble some of the symptoms of mania. Such symptoms include distractibility, irritability, and talkativeness. These difficulties are well described in DSM-IV as the less serious and far more treatable diagnosis of ADHD. Most of the symptoms of mania can easily be matched to those of ADHD. They are characteristically present most of the time and do not meet the criterion of being different form the patient’s usual self. Anywhere from 60% to 90% of children diagnosed with bipolar disorder are also diagnosed with ADHD, which is characterized by concentration difficulty and physical hyperactivity as well as difficulty controlling impulses. The ADHD diagnosis easily includes many of the behaviors described in the misdiagnosis of childhood bipolar disorder. It is common for children with ADHD to admit to racing thoughts, which is likewise the case for the bipolar disorder. The "increase of goal directed activity" of the child with bipolar disorder is similar to the ADHD symptom "often acting as if driven by a motor". The mania symptom "decreased need for sleep" is reported by parents of children with ADHD who explain that their child was always a poor sleeper and wanders the house at night. Although the ADHD diagnosis does account for several of the mania symptoms, it does not account for the angry behaviors, which are typical for children diagnosed with bipolar disorder. Anger, irritability, and aggression are not DSM symptoms of ADHD (Kaplan, 2011).
ADHD and Conduct Disorders (ODD/CD)
Many studies have concluded that the most common comorbid disorders diagnosed with ADHD in children and adolescents are conduct disorder (CD) and oppositional defiant disorder (ODD). A conduct disorder diagnosis requires a repetitive pattern of behaviors involving violation of the rights of others through aggressive actions directed at people and/or animals (physical cruelty and fighting, destruction of property, vandalism, stealing, setting fires, or runaway behaviors). According to multiple studies the presence of ADHD is a significant predictor of conduct disorder in boys ages 8 to 17. In an inpatient group of ADHD children, those with a comorbid diagnosis of conduct disorder demonstrated greater degrees of psychopathology than other groups of ADHD children. Children with the joint diagnosis of ADHD and conduct disorder perform significantly worse in academic achievement than a similar group of conduct disordered children.
The ODD is less severe than CD and involves problematic attitudes rather than destructive behaviors. These children and adolescents display non-compliance, hostility, and stubbornness towards parents, teachers, and other authority figures. Barkley (1998) reported that 54% to 67% of children with ADHD meet the criteria for ODD. A comparative clinical study of oppositional only, ADHD only, comorbid, and a control group of boys, reported that the comorbid group was more impaired than the control group. Barkley and Anastopoloulos (1992), in a comparative study of ADHD adolescents with and without the oppositional defiant characteristics, reported that the first group displayed "greater than normal" conflicts, more anger, poorer communication, and negative interactional styles (Everrett & Evert, 1999).
Everrett, C., & Evert, S., (1999). Family therapy for ADHD. New York, NY: The Guildford Press, p. 26
Kaplan, S. (2011). Your child does not have bipolar disorder: how bad science and good public relations created the diagnosis. Santa Barbara, CA: Greenwood Publishing Group, p. 17-20.
Biser Rangelov, MA MFC, LPC
Biss-Ann Counseling Services
3001 W. 5th St. Suite 400
Fort Worth, TX 76107
E-mail:[email protected]
Phone: 817.372.1107
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