Similarities and Differences: ADHD and Early Onset Bipolar Disorder

By F. Russell Crites

Some characteristics of ADHD and Bipolar Disorder look the same, but have different motivations.

Others show the same type of behavior, but it is more or less intense in some way.

This is not an exhaustive list of the characteristics of ADHD or Bipolar Disorder. However, it is a good start for those trying to get a handle on which disorder seems to be most evident. These characteristics are documented in the works of Papolos & Papolos (2002), Geller (1997), Popper (1996), Miklowitz (2002), and others.

• BREAKS THINGS:

  An ADHD child breaks things carelessly while playing (non-angry destructiveness);

  A Bipolar child breaks things as a result of anger. He has severe temper tantrums where he releases extreme amounts of physical and emotional energy. Aggression towards others and physical property damage sometimes occurs.

• ANGER:

  An ADHD child usually calms down in twenty to thirty minutes (maybe less).

  A Bipolar child child may continue to feel and act angry for up to four hours or more.

• REGRESSION:

  An ADHD child rarely regresses, e.g., displays disorganized thinking, language, and body position.

  A Bipolar child regresses and often has disorganized thinking, language and body position during the episode.

• FORGETS THE EVENT:

  An ADHD child does not lose memory of events.

  A Bipolar child may lose memory of the tantrum or event.

• TRIGGER EVENTS:

  An ADHD child is typically triggered by a lack of structure.

  A Bipolar child overreacts to limit-setting, is triggered by anxiety (look for PTSD issues), or by sensory or emotional over-stimulation.

• SLEEPING and WAKING UP:

  An ADHD child usually arouses quickly and attains alertness within minutes. However, they are tired and often do not get a good night sleep…especially hyperactive-impulsive students.

  A Bipolar child often stays up late, and is irritable upon early morning arousal. He may have slow arousal and have irritability, fuzzy thinking, or somatic complaints when he gets up (may last for a few hours).

• GETTING TIRED:

  An ADHD child seems to wear himself out and get tired during the day (this may be a medication issue).

  A Bipolar child is not usually tired during the day.

• REALITY and JUDGMENT:

  An ADHD child can see reality for what it is. He can make good judgments, but he just doesn’t take the time to do so.

  A Bipolar child is grandiose and believes that he can do things that he can’t do (impaired judgment). Doesn’t think things through, and even if he does, it is often flawed thinking.

• NIGHTMARES:

  An ADHD child may destroy the bed covers, but he does not have excessive nightmares or night terrors.

  A Bipolar child often has severe nightmares or night terrors. Themes of explicit gore and bodily mutilation are often reported.

• MOOD SWINGS:

  An ADHD child will not have significant shifts in mood, e.g., depressed to manic.

  A Bipolar child will often have mood shifts during the day, or at the least during the week.

• MISBEHAVIOR:

  An ADHD child misbehavior is often accidental and usually caused by inattention, impulsivity, or over-activity.

  A Bipolar child will intentionally provoke or misbehave. Some are seen as the ‘bully on the playground’.

• SLEEP:

  An ADHD child may sleep 5-9 hrs. However, he will often be tired because he doesn’t get good REM (rapid eye movement) sleep.

  A Bipolar child has a decreased need for sleep (3-6 hrs), e.g., may stay up late and get up early and not seem to have any bad effects from it.

• RACING THOUGHTS:

  An ADHD child has racing thoughts that are fragmented; bits and pieces of hundreds of things that distract or draw his attention.

  A Bipolar child often has racing thoughts. Will usually give concrete answers to describe his thoughts, e.g., “I need a stoplight up there.” My thoughts broke the speed limit.” Can tell you about a specific ‘topic’ he is racing about. His speech is usually goal directed.

• RISK TAKING:

  An ADHD child may engage in behavior that can lead to harmful consequences without being aware of the danger.

  A Bipolar child is often a risk, or sensation seeker.

• SEXUAL BEHAVIORS:

  An ADHD child is often immature for his age. As a result, sexuality comes along at a slower pace because of psychosocial or developmental delays.

  A Bipolar child tends to have strong early sexual interest and behavior. He may be sexually inappropriate for age e.g., use explicit sexual language, sexual pictures.

• REALITY TESTING:

  An ADHD child usually does not have psychotic symptoms or reveal a loss of contact with reality.

  A Bipolar child may exhibit gross distortions in perception of reality or in the interpretation of emotional events.

• ELATION:

  An ADHD child will be elated (Giggle, excited, extremely ‘happy’) when special events occur.

  A Bipolar child will be elated for no apparent reason, e.g., giggling in the classroom when peers are not, laughing for no apparent reason, etc. At the same time he may be sensitive or easily irritated.

• RESTLESSNESS:

  An ADHD child may have restless tension as seen in an inability to keep his legs, hands, etc. still. This occurs all day long.

  A Bipolar child will have the same problem with restlessness, but it may cycle through the day, often getting worse at night (depends on type of bipolar).

• IMPULSIVITY:

  An ADHD child can be impulsive and react to his environment, not so much his inner turmoil.

  A Bipolar child will be impulsive due to a swing in moods. If hypomanic, judgment fades. If depressed he may have a need to find a way to reduce his depression or energize himself.

• INATTENTION and POOR FOCUS:

  An ADHD child will probably be inattentive or distractible all day long, every day of the week (pending medication).

  A Bipolar child may be inattentive for a time and then become attentive as he pulls out of his depression. If he goes too far into the manic side he will lose attention again. Attention is often cyclical…may be hour by hour or day by day.

• SELF CENTERED:

  An ADHD child may be self-centered, but is usually so because of a sense of frustration at being unable to focus.

  A Bipolar child seems to be unable to see other’s perspective in a situation. He will do whatever is necessary to justify his position. Very irritable.

• SUICIDAL THINKING and SUICIDE:

  An ADHD child may talk of suicide as a control issue. Usually there is no intention, plan, etc. for follow through.

  A Bipolar child may have a morbid fantasy about death, hurting others, etc. Suicide is the leading cause of death of people with Bipolar Disorder.

• INJURY TO SELF OR OTHERS:

  An ADHD child would rarely intentionally hurt self or others. If something were to occur it would be more of an accident due to inattention.

  A Bipolar child will intentionally hurt self or others with purpose. This purpose will often seem to be malevolent or grandiose in nature, i.e., creative ways to hurt someone who has offended him.

• RAGES:

  An ADHD child will have non-directive meltdowns. They are usually short in duration.

  A Bipolar child will go into a rage and direct it at a person, or some available target. It is deliberate and intentional in nature. He may attack those in authority.

• TALKS A LOT:

  An ADHD child may speak out of turn (even have a lot to say), but can be redirected to task.

  A Bipolar child, when in a manic state, will have a verbal outpouring, speaking without stop even when someone tries to stop him.

If your child has more characteristics on the bipolar side of this chart, you may want to consider the possibility that your child may have bipolar disorder instead of ADHD. Consult with your doctor to discuss what may need to be done.

F. Russell Crites, M.S., L.P.C., L.M.F.T., L.S.S.P.
Contact Mr. Crites by email
Visit his website to learn more.

F. Russell Crites, Jr., has worked for the public schools, been a consultant for public and private schools as well as psychiatric hospitals, and has had a private practice for over twenty years. He hold licenses as a specialist in school psychology (LSSP), a professional counselor (LPC), a marriage and family therapist (LMFT), is a Clinical Member of the American Association of Marriage and Family Therapy (AAMFT), is a Certified Hypno-Therapist, and holds other certifications.

Over the years he has spoken in many local, state and regional conferences regarding Bipolar Disorder, ADHD, Oppositional Defiant Disorder, Drug and Alcohol issues, Marriage and Family issues, Parenting, and much more. Russ has also provided staff development for multiple school districts.

He is the Founder and Director of Crites Psycho-educational Consultants. Russ completed a B.S. in psychology and a M.S., in Clinical/Counseling psychology from Abilene Christian. He can be reached at rcrites AT sbcglobal.net or through his web site at www.cpccom.com .

Article References:
* Carlson GA, Jensen PS, Nottelmann ED, eds. Special issue: current issues in childhood bipolarity. Journal of Affective Disorders, 1998; 51: entire issue.
* Geller B, Luby J. Child and adolescent Bipolar Disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76.
* Geller, B., Williams, M., Zimerman, B., Frazier, J., Beringer, L., and Warner, K. L. Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms; grandiose delusions; ultra-rapid or ultradian cycling. Journal of Affective Disorders , 1998.
* Strober, M., Morrell, W., Lampert, C., and Burroughs, J. Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: A naturalistic study. Am J Psychiatry 147, 457-461, 1990.
* Miklowitz The Bipolar Disorder Survival Guide. New York: Guilford, 2002.
* Papolos and Papolos, The Bipolar Child. New York: Broadway Books, 2002.
* Popper, C. Diagnosing Bipolar vs ADHD: A Pharmacological Point of View. The Link 13: 1996.

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