Attention Deficit Hyperactivity Disorder (ADHD) versus Bipolar Disorder

By Candida Fink, Joe Kraynak

The diagnostic criteria for mania clearly overlap with those for ADHD. Distinguishing between the two conditions is critical because treatment for ADHD is different from treatment for bipolar.

For instance, the stimulants used to treat ADHD, such as Adderall (a combination of dextroamphetamine and amphetamine) and Ritalin (methylphenidate), can wreak havoc in a manic child, and antimanics, which can help with mania, don’t help kids with ADHD. Here we explore the similarities and differences between ADHD and bipolar disorder and the possibility of the two conditions existing together.

Identifying shared symptoms of mania and ADHD

Mania and ADHD share a number of core symptoms that center on energy, impulse control, and mood reactions. Some important overlapping symptoms include

  • High energy levels

  • Excessive talking

  • Poor impulse control

  • Inattention/distractibility

  • High risk taking/stimulus seeking

  • Impatience/trouble delaying gratification

  • Moodiness/short fuse (although this isn’t a diagnostic criterion for ADHD, it’s a commonly occurring associated symptom)

Distinguishing bipolar from ADHD

What are the differences between symptoms of mania and those of ADHD? How do you sort them out? The following considerations are important to evaluate when making a diagnosis:

  • Cycling/change from baseline: In bipolar disorder, the manic and hypomanic symptoms typically come in episodes. In ADHD, the symptoms are chronic (present all the time).

  • Grandiosity: Mania causes a person to be full of irrational confidence and certain that she can do anything and achieve everything that she imagines. Markedly distorted feelings of power and ability aren’t part of ADHD. In fact, kids with ADHD typically struggle with low self-confidence and a sense that they’re doomed to failure. Grandiosity is a red flag for mania.

  • Sleep disturbance: Kids with ADHD often have trouble quieting their minds to sleep; these kids are usually fatigued the next day and have a difficult time waking up. In mania, kids need little sleep; they stay up late, get up early, and keep on going. They eventually crash, exhausted, but they have sustained periods of high energy with less need for sleep.

  • Euphoria: Mania can be diagnosed in someone who has only angry, irritable moods — a symptom that’s also associated with ADHD. However, the presence of euphoria — an expansive, overly happy mood with a persistent sense that everything is beyond wonderful, that everything is easy, even when life throws its usual curve balls — is part of mania, but not part of ADHD.

Considering comorbidity: ADHD and bipolar

How common is it for kids with bipolar disorder to also have ADHD? Can a child have both conditions? Research shows that bipolar disorder causes problems with attention and concentration, even between mood episodes. If a child is diagnosed with bipolar disorder, she’ll likely have problems listening, focusing, and following directions. Teasing out the two diagnoses is a challenge for treating doctors and researchers. If your child has been diagnosed with both disorders, she’ll require especially careful treatment planning.