Bipolar Disorder and ADHD Comorbidity Diagnosis and Treatment

Diagnostic Considerations in Young Patients

• The American Academy of Child and Adolescent Psychiatry notes that the validity of bipolar disorder diagnosis in young children remains controversial, with particular caution needed in preschool children 1
• Symptoms such as manic-like behaviors in children with ADHD can be commonplace in youth with disruptive behavior problems, and irritability can be present in both conditions but differs in quality and pattern 2, 3

Treatment Implications for Comorbid Conditions

• The American Academy of Child and Adolescent Psychiatry recommends treating bipolar disorder first before addressing ADHD symptoms, with mood stabilizers and atypical antipsychotics as primary treatments for bipolar disorder, and stimulants may be used for ADHD symptoms once mood is stabilized 4, 5
• A randomized controlled trial demonstrated that low-dose mixed amphetamine salts were safe and effective for treating ADHD symptoms once mood was stabilized with divalproex in bipolar children and adolescents with ADHD 6

Medication Considerations and Monitoring

• Studies challenge the belief that stimulants necessarily precipitate progression to bipolar disorder, with two studies finding that boys with ADHD plus manic-like symptoms responded as well to methylphenidate as those without manic symptoms, and stimulant treatment did not precipitate progression to bipolar disorder in these studies 4
• Regular monitoring is essential for symptom changes, potential medication side effects, and maintenance therapy is often needed for 12-24 months or longer to prevent relapse in bipolar disorder patients 6