Differences Between ADHD & Bipolar Disorder in ChildrenIn children, it can be difficult to differentiate between pediatric bipolar disorder (PBD) and attention deficit hyperactivity disorder (ADHD). They are genetically linked, have multiple overlapping symptoms and co-occur at a rate of 60-80%. However, both disorders have distinct characteristics that are important to note. A new study looks at differences found between those with pediatric bipolar disorder and ADHD, focusing on emotional control, memory and inhibition.

The prevalence of pediatric bipolar disorder is not clear, but there are estimates that between less than 1% and 3.3% of children have the disorder. Part of the discrepancy is because pediatric bipolar disorder is difficult to recognize. It does not exactly mimic the criteria set for adults with the disorder. In PBD, moods are not necessarily distinctive or tend to cycle quickly. Mania may lack grandiosity but exhibit irritability. Instead of full depression and mania, children may experience cyclothymia, which is made up of less severe mood swings. More symptoms of PBD include:

  • Talkativeness with frequent subject changes
  • Problems with attention
  • Problems with inhibition
  • Overly excited or silly
  • Extended episodes of rage
  • Having trouble sleeping
  • Increased amounts of sadness
  • Feelings of guilt
  • Changes in eating habits
  • A sudden or gradual lack of interest in activities
  • Complaints of aches or illness

ADHD in children is far more common, with estimates as high as 11%. ADHD may present differently in some children. Boys may be more hyperactive and impulsive while girls may be considered daydreamers or overly anxious. Symptoms of ADHD include:

  • Problems with attention
  • Difficulty completing tasks like chores or homework
  • Having trouble with organization
  • Easily distracted
  • Talkativeness
  • Fidgeting
  • Overly excited or active
  • Problems with inhibition

Overlaps in PBD and ADHD symptoms generally lie in what is called executive function or cognitive function. It’s how the brain processes perception and understanding. The main processes affected are attention, emotional control, memory, critical thinking, planning, organization and some language skills. Adults and children with either bipolar disorder or ADHD have problems in these areas to some extent. With bipolar disorder, the extent of the difficulties may follow mood patterns.

Although PBD and ADHD share these cognitive symptoms, some differences between the two may be found in the extent to which the symptoms present. A new study published in the fall edition of the Journal of the Canadian Academy of Child and Adolescent Psychiatry looked at to what extent children with each of these disorders experiences problems with executive function.

The research team, led by Dr. Alessandra M. Passarotti, examined 16 children and adolescents with PBD, 17 with ADHD and 13 of whom have both disorders. The participants were screened for attention, working memory and cognitive flexibility while parents were surveyed about the children’s behavior and executive functioning. After analyzing the data, the following differences were found between the subjects:

The PBD group and the co-occurring group had more deficits than the ADHD group in cognitive function, especially critical thinking and emotional control. Deficits in emotional control can lead to children overreacting to situations or having trouble responding to situations appropriately as well as having difficulties controlling or understanding their own emotions.

The same group showed more impairment in areas like shifting, which is being able to move from one activity or subject to another without difficulty. Inhibition and the ability to self-monitor were also more apparent in this group.

The children with ADHD stood out from those with PBD mostly looking at problems with memory, planning/organization and self-monitoring.  Memory problems can lead to difficulty retaining relevant information. Having deficits in planning and organization can be especially difficult when it comes to setting and completing goals or organizing thoughts and information. Self-monitoring was also an issue in the group with ADHD alone, providing more of an overlap.

 

As a parent, knowing what to look for in a child’s behavior and taking note of a child’s struggles can help mental health care professionals better distinguish between the two disorders. This can lead to different diagnoses and treatment plans that are more specific to a child’s needs and lead to better quality of life overall.

 

 

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Image credit: r. nial bradshaw