While attention deficit hyperactivity disorder (ADHD) is the most common diagnosis for children who display unusually hyperactive symptoms, it is crucial not to rule out the possibility of childhood-onset bipolar disorder.
Since “using stimulant medications to treat ADHD or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms” (3), the importance of accurately distinguishing between these two cannot be overstated. Though the signs can very often be similar, including behavioral and emotional instability, the differences, too, are just as telling.
One of the first noticeable contrasts between these two disorders results from motivation. While a child with ADHD may destroy a possession accidentally through negligence, a bipolar child is much more likely to do so out of anger.
The tantrums of bipolar children may also last for hours, whereas those with ADHD would not likely go longer than a half-hour (1). During these tantrums, the energy expended by a bipolar child could amount to an extreme level of physical activity, which children with ADHD would not reach.
Some other symptoms that separate these two disorders include both the perceived reality and the temperament of the child. Although ADHD does not result in psychotic delusions, unless coupled with a preexisting psychotic condition, those with bipolar may very well experience paranoia and other reality distortions (1). They are also more emotionally unstable, with episodes of both depression and mania.
Yet often times the first recognized indication of either bipolar disorder or ADHD is a difficulty in learning. While these two disorders may share similar symptoms, such as trouble comprehending and the reading disorder dyslexia, there are additional traits that separate them.
For untreated ADHD, there is a strong likelihood that the child may exhibit inattentiveness and distractibility for the entire day, whereas those with bipolar are capable of paying attention as long as both their depression and mania are under control (4).
However, in a manic state, children with bipolar can be excessively talkative to the point of not stopping even after there's been an attempt to restrain them. Though ADHD can often result in talkativeness, the child can be redirected and kept on task. It is also important not to overlook these symptoms even if the child is uncommonly bright and creative, as this too can be a characteristic of both disorders.
Although the most noticeable symptoms are seen during the waking hours, key signs take place while the child is in bed. They can include, for bipolar disorder, horrific nightmares of “explicit gore and body mutilation” (1). As a result, the child is much more apt to try to avoid sleeping altogether. In the morning, they are likely to be very slow to adjust and inconsolable when awoken. Yet children with ADHD have mainly exhibited only a difficulty in falling asleep, caused in part by their level of hyperactivity.
To summarize these two disorders, with the exception of the ability to focus, the most severe symptoms are generally found in children with bipolar disorder. They are harder to keep under control, have more extreme mood swings, and are intentionally confrontational with any authority figure.
Bipolar disease is a chronic disorder, but can be treated with mood-stabilizing medication such as Lithium. However, without proper treatment, bipolar disorder can become more serious as the child grows, since this enables them to act out in more physical ways. Managing the levels of prescriptions as the child becomes older, though challenging, is crucial in finding an effective way to control the symptoms.
Though ADHD is also a lifetime disorder, it tends towards improvement as the child grows into adolescence and adulthood. Stimulant medications such as Ritalin can also keep temporary moments of fear and anxiety from worsening the symptoms.
For concerned parents, the first step towards recognizing their child's condition is to contact a physician. Since there is a significantly higher risk for children in families with a history of these two conditions as well as those that have other mood disorders, it is important to share this information with their doctor immediately.
Popper, Dr. Charles. “Diagnosing Bipolar Vs. ADHD: Similarities.” ADHD News.
1. “ADHD Kids May Have Bipolar Disorder, Too.” WedMD 29 Oct. 2002.
2. “Treatment of Children with Mental Disorders.” National Institute of Mental
Health 24, Feb. 2004.
3. Crites, F. Russell. “Similarities and Differences: ADHD and Early Onset Bipolar Disorder.” The ADHD Information Library.
4. “Educating the Child with Bipolar Disorder.” Child and Adolescent Bipolar Foundation 2007.