Is It ADHD or Bi-Polar Disorder?

October 13, 2008

Some of the symptoms common to both ADHD (Attention Deficit Hyperactivity Disorder) and Bipolar Disorder are so similar that it is easy to misdiagnose one for the other. ADHD, for example, has most likely been over-diagnosed. Bipolar Disorder, on the other hand, is believed to be under-diagnosed. And both are easily and often misdiagnosed.

The three characteristics of inattentiveness (lack of focus), impulsiveness and hyperactivity associated with ADHD are also present in Bipolar Disorder. They are manifested differently mainly in their duration.

Inattentiveness and lack of focus in ADHD lasts all day long; while with bipolar disorder it goes in cycles, lasting for a few hours to a few days, depending on the duration of the depressive episode common to bipolar disorder.

Impulsiveness in ADHD is a reaction to the surroundings; while in bipolar disorder it results from mood swings and the necessity to ease the depression and re-energize.

Hyperactivity in ADHD manifests in fidgeting and the inability to keep still which lasts all day; in bipolar disorder it cycles throughout the day usually getting worse at night.

Differentiating between ADHD and bipolar disorder as a result of these symptoms becomes difficult and children are commonly misdiagnosed. Since ADHD is a more common condition in children it's often the first thing a doctor thinks of.

There are many other similarities that coexist in ADHD and bipolar disorder. Below is a list of just a few of these.

Reality: a person with ADHD does not lose touch with reality; a person with bipolar disorder does lose touch with reality during a temper tantrum and has a distorted understanding of the emotional events.

Anger: lasts only about 20-30 minutes with ADHD but could go on for up to 4 hours with bipolar disorder.

Temper Tantrums: will last only a few minutes with ADHD without any violence or destruction; the temper tantrum will be remembered. In bipolar disorder these tantrums are violent and last for hours accompanied by hitting and kicking, throwing things, destruction of property and threats to do harm to others; the tantrum and the events leading up to it will not be remembered.

Misbehavior: those with ADHD have difficulty with behavior resulting from lack of attention/focus, impulsiveness, or over stimulation. In bipolar disorder, misbehavior as well as provocation are deliberate and intentional. More often than not these are the "bullies" in schools.

Judgment: those with ADHD are quite capable of making good judgments, they just don't take the time to do so. Those with bipolar disorder have impaired judgment with fantasies of doing things they cannot and they don't think things through.

Triggers: for ADHD it's simply a lack of structure that triggers a temper tantrum. For bipolar disorder it's a deliberate rebellion against authoritative figures and the limits they set, which cause feelings of anxiety.

Nightmares: those with ADHD rarely, if ever, have nightmares; while those with bipolar disorder have nightmares and night terrors full of gore and detailed mutilation.

While irritability and aggressiveness can indicate bipolar disorder they can also be symptoms of ADHD. Some children could have an aggressive, manic reaction to medications they are taking for their ADHD.

Approximately 15% of children suspected of having ADHD may actually have early onset bipolar disorder. In the past bipolar disorder has been attributed to adults, not to children and adolescents. Because of the close similarities of ADHD and bipolar disorder, 80% of children with bipolar disorder meet the full criteria of attention deficit hyperactivity disorder. As a result, it is extremely important that bipolar disorder be ruled out before a diagnosis for ADHD is given.

The major difference between ADHD and bipolar disorder is that ADHD affects attention and behavior, while bipolar disorder is mainly a mood disorder. The tendency for ADHD is to improve over time, but for bipolar disorder the tendency is to get worse, especially if proper treatment is delayed.

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