Parents who have children with attention deficit hyperactivity disorder may have concerns that their child could also develop bipolar disorder as an adult since the symptoms can be somewhat similar and often overlap.
However, experts maintain that the likelihood of this happening based strictly on the fact that a child has ADHD is low, and they stress the need to distinguish between two key points: There’s a difference between a bipolar child who may also have ADHD as a coexisting condition, and wondering if a child who has ADHD is likely to develop bipolar disorder as an adult.
“ADHD is extremely common among youth who have been diagnosed with bipolar disorder,” says Dr. David Rettew, director of the Pediatric Psychiatry Clinic at the University of Vermont Medical Center. “In some studies of bipolar disorder, the comorbidity with ADHD approaches 100 percent.” He explains that this may have to do with diagnostic criteria overlap between the two conditions, both of which can include hyperactivity, distractibility and excessive talking. “When you meet criteria for one, you’re well on your way for meeting criteria for the other.”
[See: 10 Concerns Parents Have About Their Kids’ Health.]
Overlapping Symptoms
In fact, the National Institutes for Mental Health explains that bipolar disorder, which is also known as a manic-depressive illness, is commonly marked by distinct mood shifts in which manic or depressive episodes may occur. Manic symptoms, according to the NIMH, include feelings of elation, talking fast, agitation and the belief that several things can be achieved at once. On the other hand, depressive episodes involve feelings of sadness, forgetfulness, an inability to concentrate, diminished energy and trouble sleeping.
Compared to ADHD, in which symptoms may also involve talking fast and trying to do several things at once (the hyperactive component) or possibly feeling forgetful (the inattentive component), Rettew says it’s easy to understand how parents may question overlapping behaviors in their child and wonder if he or she will develop bipolar disorder later in life.
However, Rettew explains that the question of whether a child diagnosed with ADHD will develop bipolar disorder in adulthood “is more controversial” and a topic of ongoing debate. “The main reason this question is so controversial is that the diagnosis of bipolar disorder opens the door to using certain classes of medications,” such as antipsychotics, which he says can render many people hesitant, especially if he or she is taking a psychostimulant to treat their ADHD as well.
Experts Discuss Studies, Medications
Dr. Edward Hallowell, founder of the Hallowell Centers in Boston, New York City, San Francisco and Seattle, cuts to the chase about whether a child with ADHD will likely develop bipolar disorder as an adult. “The answer is no,” he says, citing not only his many years of experience with children and adults who have cognitive and emotional issues, but a 2015 study published in World Journal of Psychiatry which states that “ADHD status is not a risk factor for developing BD over 14 years of follow-ups.”
As for ADHD medications, Hallowell is an advocate, stating that people are often too easily “afraid that stimulants will precipitate manic episodes or lead to addiction,” — thoughts that he says are “unfounded fears.” He says there’s no reason why a person with ADHD shouldn’t try medication designed to help improve his or her symptoms.
Still, concerns about medications — specifically if they play a role in exacerbating other symptoms and lead to other disorders — exist. Robert McNamara, professor in the Department of Psychiatry and Behavioral Neuroscience and director of the Lipidomics Research Program at the University of Cincinnati, tells the university’s health center that “because youth at risk for bipolar disorder often initially present with ADHD, they are commonly prescribed a psychostimulant medication, and it is presently unknown whether this increases risk for precipitating the onset of bipolar disorder.” Along with a university colleague, he’s examining this topic by studying brain changes that may occur with psychostimulant treatment.
[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]
Family History Matters
Hallowell, who is the author of “Delivered from Distraction” and “Driven to Distraction at Work,” also explains that family history plays a role; whether relatives have bipolar disorder can increase the likelihood that a child could develop it.
The NIMH reinforces this family history component, noting that “while it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder.”
Jumping to Conclusions
Hallowell adds that much of what’s believed about this topic is often steeped in “cursory glances.” He says that “people may see someone who is energetic and be quick to say they’re manic, but that’s not necessarily true.” It could be that they’re simply exhibiting the hyperactive component of ADHD, and he encourages people not to jump to bipolar disorder conclusions because of one behavior.
Additionally, he points out that bipolar disorder is a mood disorder that, while it may coexist with ADHD, is not itself part of ADHD.
The authors of an article in Current Psychiatry make this clear by stating that “bipolar disorder is a problem with mood. Children with bipolar mania are elated and/or irritable and experience mood states that appear uncontrollable.” ADHD, on the other hand, “is a problem with cognitive functioning, including attention, distractibility, and energy level.”
Rettew, who is the author of “Child Temperament: New Thinking About the Boundary Between Traits and Illness,” touches on hastily made assumptions involving this topic, saying that there’s often a blurry line as to what behaviors constitute the makings of a potential bipolar disorder as opposed to a personality trait that’s typical for a certain age.
“Adolescents with mania also may have huge bursts of energy and may frantically begin multiple projects, working on them through the night,” he says. “At times, there may even be delusions that a person has exceptional powers and abilities, and they actually act upon those beliefs.” But he says such grandiosity can “sometimes be a little tricky to diagnose,” as there are plenty of youngsters who think they’re capable of doing remarkable things, yet such thoughts aren’t always pathological. “The key is how they act. When I was a kid, I thought I had a shot at pitching for the Phillies, but I never showed up at training camp,” Rettew says.
Current Psychiatry adds that “All children sometimes say self-inflating things, but those with pathologic grandiosity cross the threshold into the dysfunctional belief that they are better, stronger, smarter, or more talented than others.” The authors explain that children with ADHD aren’t typically grandiose, another differentiating point.
[See: Hoarding, ADHD, Narcissism: Inside the Minds of History’s Great Personalities.]
Focus on the Positive
Hallowell says it’s important to focus on living the life that best works for a person with ADHD, which should include worry-free thoughts that bipolar disorder may be on the horizon. He stresses the importance of remembering that it’s a separate condition and that just because a person has ADHD as a child, it doesn’t mean he or she will get bipolar disorder as an adult by default.
“It’s not just about taking medications and leaving it at that,” he says, or just addressing only one aspect of ADHD, but rather turning to these multiple steps in an effort to make the most out of living with ADHD and move forward in a positive direction.
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Can Having ADHD as a Teen Mean Developing Bipolar Disorder as an Adult? originally appeared on usnews.com
