Q:  Bipolar and ADD

Dear Dr. Phelps,

Wow! Today I found answers to many questions that have been troubling me since my 12 yr. old son was diagnosed with ADD/Bipolar Disorder 1-1/2 years ago.

What are your views on the issue of ADD being MISDIAGNOSED as BIPOLAR DISORDER?  

Also after recent auditory/developmental testing, we found out that my son's I.Q. level was considered "gifted."  He has been in a g.t. program for years and the I.Q. test confirmed our speculations about his intellectual gifts.  But after researching the EMOTIONAL TRAITSseemed to only raise questions about his diagnosis of ADD/BP?

Dear Melissa -- 
You have your finger on a very important issue, but unfortunately one about which we know very little and as a field (psychiatry) are really struggling.  Here is a review of the topic you can dig up (the abstract alone doesn't help much, as you can see):   

Giedd JN.  J Clin Psychiatry 2000;61 Suppl 9:31-4  Bipolar disorder and attention-deficit/hyperactivity disorder in children and adolescents.   Child Psychiatry Branch, National Institute of Mental Health, Bethesda, Md 20892, USA. jgiedd@helix.nih.gov
The relationship between bipolar disorder and attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has been one of the most hotly debated topics in recent child psychiatry literature. At the heart of the matter is whether large numbers of children with bipolar disorder are being unrecognized or misdiagnosed. The differential diagnoses of juvenile-onset bipolar disorder can be complicated by many factors, but the most common clinical dilemmas seem to arise from overlapping symptomatology with ADHD and the differing treatment strategies these diagnoses imply. This article discusses the similarities and differences between these disorders with respect to phenomenology, epidemiology, family history, brain imaging, and treatment response. 

Here is an example of the kind of research being done in this area: 

2. The BE-FIRST Study (Bipolar Early Family Intervention Research Study Team) The George Washington University seeks 7-14 year-old boys with behavioral problems with one parent diagnosed with bipolar disorder. The clinical trial is designed to assess medication treatment of Depakote for at-risk children with behavioral problems such as Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Adjustment Disorder which are associated with an increased risk for the onset of bipolar disorder. The Principal Investigator, Dr. David Mrazek, Professor and Chair of Psychiatry and Behavioral Sciences at Mayo Clinic, is collaborating with the Principal On-site Investigator, Kate Plaisier, M.D., as well Frederick Goodwin, M.D., Adelaide Robb, M.D., and Steven Pankopf, M.D. Families in the Washington, DC area that are interested may ca! ll the BE-FIRST hotline at (202) 994-2522.

The "bottom line" is that we can't distinguish between these two entities well, and the younger a child is, the harder the distinction.  However, here's one encouraging study that suggests if we call it ADHD and treat with Ritalin, that we won't (according to the data from this one study) be making bipolar disorder worse: 

3. Carlson GA, Loney J, Salisbury H, Kramer JR, Arthur C.   J Child Adolesc Psychopharmacol 2000 Fall;10(3):175-84  Stimulant treatment in young boys with symptoms suggesting childhood mania: a report from a longitudinal study.  

You can read the abstract here and click on the blue icon at the top of the page there to read the whole article if you wish. 

 Dr. Phelps


Published April, 2001