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Attention-deficit hyperactivity disorder – bipolar comorbidity in children and adolescents


  • GM has received research grants and is a consultant for Eli Lily & Co., and has served on the speakers bureau for Eli Lily & Co., GlaxoSmithKline, Janssen Cilag, and Pfizer. GP is a consultant for Boehringer Ingelheim and Novartis Farma and is a member of the speakers bureau for GlaxoSmithKline, Eli Lilly Italia, Lundbeck Italia, Pfizer, Sanofi-Synthélabo, AstraZeneca and Wyeth Lederle. SM and CP have served on the speakers bureau for Eli Lily & Co. CT, MM and NB have no reported conflict of interest.

Gabriele Masi, MD, IRCCS Stella Maris, Via dei Giacinti 2, 56018 Calambrone, Pisa, Italy. Fax: +39-50-886247;


Objective:  A substantial portion of juvenile bipolar disorder (BD) has a comorbid attention-deficit hyperactivity disorder (ADHD). The aim of our study was to analyze the cross-sectional and longitudinal implications of such comorbidity in children and adolescents with BD.

Methods:  Ninety-eight refereed patients (mean age 13.7 ± 3.0 years) with a diagnosis of BD by the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime version (K-SADS-PL) were followed for 6 months.

Results:  Thirty-seven BD patients (37.8%) presented a lifetime diagnosis of comorbid ADHD. The mean age of onset of ADHD was 3.7 ± 1.1 years, and the mean age of onset of BD was 10.0 ± 3.2 years. Bipolar subjects with comorbid ADHD were predominantly male, younger, and had an earlier onset of BD (8.1 ±  2.8 versus 11.1 ± 2.9 years). Bipolar-ADHD patients presented more frequently a chronic rather than an episodic course of BD, with an irritable rather than an elated mood. They showed higher rates of oppositional defiant disorder/conduct disorder, lower rates of panic disorder, and less frequently received antidepressant medications. Finally, ADHD comorbidity was associated with a greater psychosocial impairment.

Conclusions:  ADHD comorbidity is frequent in juvenile BD and can influence age of onset, phenomenology, comorbidity, and course of BD. A timely diagnosis should improve our efforts regarding the outcome of these subjects.