Attention Deficit Hyperactivity Disorder, or ADHD, starts out in early childhood. In fact, symptoms of ADHD have to be present before the age of 12 in order to receive a diagnosis. It’s characterized by inattention, hyperactivity, and impulsivity. Between 3-12% of children are estimated to have ADHD. Half of those will eventually grow out of it, but the other half are unfortunately stuck with it into adulthood. Adult ADHD is particularly difficult to handle on a diagnostic basis. The hyperactivity dwindles, which makes it harder to identify if a childhood diagnosis was never made. Also at that point, many symptoms of ADHD can mimic those of bipolar disorder. So is it one, the other or both?
Bipolar disorder very rarely exists on its own. There is an 88-95% chance that at least one other psychiatric illness will come along for the ride. That means that in the mental illness cluster that includes things like ADHD, depression, bipolar disorder, anxiety disorder, PTSD, OCD and substance abuse, ADHD and bipolar disorder are often found alongside at least one of the other mental illnesses. About a third of people with bipolar disorder end up having ADHD set up shop inside their heads as well. Children with ADHD have a higher chance of developing bipolar disorder in the future.
The reason it’s sometimes hard to distinguish bipolar disorder from ADHD is that the two disorders have a lot of similarities, symptom-wise. Both include the classic restlessness and impulsivity. Adult ADHD can also be characterized by mood swings. These similarities don’t just occur in bipolar mania either. Both in ADHD and in bipolar disorder, even in between bipolar phases, patients can experience lack of focus, memory problems, and a number of other cognitive function impairments. Psychological symptoms aside, both disorders come with increased chances of substance abuse, relationship problems, trouble with employment as well as other social ramifications.
Diagnosis can be especially difficult for women and girls. ADHD in girls often does not display itself as the stereotypical boisterous or hyperactive. Girls are more prone to daydreaming and disorganization- symptoms that aren’t as likely to attract attention. With boys, ADHD tends to lessen as they start hitting puberty, where many girls may not even begin having symptoms until puberty or even until they reach young adulthood. This lowers the chances of early detection and often leaves women living with symptoms and without treatment.
So if they’re so similar, how do you know it’s more than one disorder? Good question. The fact is, not all of the symptoms overlap. Each disorder still has its own distinct characteristics. For example, with ADHD, patients are often disorganized, inattentive, passive and lose things easily. With ADHD, rumination and extreme focus are not typically present, but are present with bipolar disorder. With bipolar mania there are also instances of grandiosity and ignoring potentially damaging consequences. Depression is always present with bipolar disorder, but not necessarily with ADHD. Bipolar disorder is also cyclical and episodic, whereas ADHD is constant.
Once a psychiatric professional diagnoses a patient with both disorders, the challenge becomes treating both disorders. ADHD is famously treated with stimulants like amphetamine salts (Adderall). The problem is, these can trigger or worsen mania symptoms. Bipolar disorder should be considered the primary focus when treating both disorders concurrently. In fact, with mood stabilizers and atypical-antipsychotics, symptoms often improve for both bipolar disorder and ADHD. If symptoms of ADHD are not diminished with the treatment of bipolar disorder, it is possible to return to the use of minimal amounts of stimulants along with the previous bipolar disorder treatments.
Because of the high rate of comorbidity between these two disorders, there are recommendations that every bipolar disorder patient should be screened for ADHD as well. It’s an important discussion that you should have with your medical team. Together you can find the best treatment for you.
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Photo credit: Scott Robinson