Characteristics of ADHD and Bipolar Disorder

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.

FDA Approves Risperdal for Early Onset Bipolar Disorder

On August 22, 2007, the Food and Drug Administration approved Risperdal, a widely used adult psychiatric drug, for the treatment of schizophrenia and bipolar disorder in children and adolescents. The FDA is permitting use of Risperdal for schizophrenia in youths aged 13 to 17, and for bipolar disorder for children and teens ages 10 to 17.

The FDA had not yet approved any drug for the treatment of schizophrenia in children or teens, and only lithium had been approved as a medication for bipolar disorder in adolescents.

NIMH Funds Research for Early Intervention in Childhood Bipolar Disorder

Press Release: June 4, 2007

NIMH recently approved funding to test the effectiveness of an early intervention in children at high risk for developing bipolar disorder. Though early in the research process, the long-term goal of this study is to reduce or delay the development of bipolar disorder in at-risk youth, heading off the effects of the disorder before it disrupts healthy development and functioning.

Family-focused therapy (FFT) involves teaching patients and their families about bipolar disorder and disease management, improving communication skills, and developing problem-solving skills. Past research has shown that FFT, when used with medication treatment, can help prevent recurrences and reduce symptoms in adults and teenagers diagnosed with bipolar disorder. The recently approved study aims to develop FFT for children, ages 9-17, at high risk for developing bipolar disorder. High risk indicates children who have some symptoms of bipolar disorder, but do not show all the symptoms required for a formal diagnosis, and have an immediate family member with bipolar disorder. Twelve children will participate in this phase of the study. The second phase will then compare FFT to treatment as usual, which includes any treatment prescribed by the patient's doctor. Children in both groups will receive medications if needed to help manage symptoms of bipolar disorder, although they do not have to take medications to participate. The researchers expect to include 40 high-risk children for this phase. Depending on the results of this three-year pilot study, a larger-scale trial may be developed.

"As they develop, children go through various learning experiences and developmental milestones," said Joel Sherrill, Ph.D., head of the NIMH Child and Adolescent Psychosocial Intervention Research Program. "Bipolar disorder can interrupt development, so if we can prevent or delay the onset of illness episodes, children with bipolar disorder might have a more typical developmental course."

The study will be conducted at the University of Colorado, led by David Miklowitz, Ph.D.; and Stanford University, led by Kiki Chang, M.D.

"We've known for a long time that bipolar disorder strongly impairs the functioning of the individual and causes considerable distress for the family," Dr. Miklowitz said. "Typically, a person undergoes treatment only after he or she is already diagnosed with bipolar disorder. This study is different in that it will help us determine whether we can minimize future impairments by intervening prior to the first episode."

The classic definition of bipolar disorder includes extreme, sustained mood swings that range from over-excited, elated moods and irritability—the manic phase of the disorder—to depression. In the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)—a large, national research study determining the best treatment practices for the disorder—of the first 1,000 participants enrolled, more than half of all cases began before age 18. Current research also suggests that onset during childhood is a sign of a more severe form of the disorder.

Posted: 06/04/2007 National Institute of Mental Health