The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children
Version of Record online: 27 NOV 2006
Volume 8, Issue 6, pages 710–720, December 2006
How to Cite
Singh, M. K., DelBello, M. P., Kowatch, R. A. and Strakowski, S. M. (2006), Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children. Bipolar Disorders, 8: 710–720. doi: 10.1111/j.1399-5618.2006.00391.x
- Issue online: 27 NOV 2006
- Version of Record online: 27 NOV 2006
- Received 3 February 2006, revised and accepted for publication 13 June 2006
- attention-deficit hyperactivity disorder;
- bipolar disorder;
- family studies;
Objectives: Pediatric bipolar disorder (BPD) and attention-deficit hyperactivity disorder (ADHD) co-occur more frequently than expected by chance. In this review, we examine 4 potential explanations for the high rate of this common co-occurrence: (i) BPD symptom expression leads to overdiagnosis of ADHD in BPD youth; (ii) ADHD is a prodromal or early manifestation of pediatric-onset BPD; (iii) ADHD and associated factors (e.g., psychostimulants) lead to the onset of pediatric BPD; and (iv) ADHD and BPD share an underlying biological etiology (i.e., a common familial or genetic risk or underlying neurophysiology).
Methods: Peer-reviewed publications of studies of children and adolescents with comorbid BPD and ADHD were reviewed.
Results: There is a bidirectional overlap between BPD and ADHD in youth, with high rates of ADHD present in children with BPD (up to 85%), and elevated rates of BPD in children with ADHD (up to 22%). Phenomenologic, genetic, family, neuroimaging, and treatment studies revealed that BPD and ADHD have both common and distinct characteristics. While there are data to support all 4 explanations postulated in this paper, the literature most strongly suggests that ADHD symptoms represent a prodromal or early manifestation of pediatric-onset BPD in certain at-risk individuals. Bipolar disorder with comorbid ADHD may thus represent a developmentally specific phenotype of early-onset BPD.
Conclusions: The etiology of comorbid BPD and ADHD is likely multifactorial. Additional longitudinal and biological studies are warranted to clarify the relationships between BPD and ADHD since they may have important diagnostic and treatment implications.