DIFFERENTIATE BIPOLAR DISORDER FROM ADHD, OR BOTH?
- Bipolar disorder: core feature – mood/affective disorder, usually recognized in adolescence or later
- ADHD: core feature – cognitive disorder affecting focus, concentration and memory, usually recognized in childhood (by 7 years old)
ADHD is a bit of misnomer because its not really attention deficit disorder and this is what fools many physicians. A deficit means there’s a lack of attention but its really an attention inconsistency. When children are interested in something, such as a computer game, they focus very well. It’s the dry, boring stuff, the things you have to learn in school where the problem arises. Young children who are having trouble keeping up with their peers start getting anxious and depressed, even in the 9 to 10 age group. From there they may get into substance abuse and often opposition defiant disorder, perhaps other problems with behavior (stealing, lying, fire setting).
When you start peeling away the layers and discover that the problem started in the teenage years and it has to do with affect, you’re most likely dealing with bipolar. If it started at 7 or 8 and the core feature is cognitive and learning, you’re most likely dealing with ADHD.
There’s also a 20-30% overlap between these two disorders.
For every ten adults with a mood disorder, one of them also has ADHD. For every ten adults in whom ADHD is diagnosed first, four also have a mood disorder and five also have an anxiety disorder
Impact of development on ADHD.
Inattention starts at around age 4,5,6 and often increases throughout life because ADHD has a condition that affects the frontal lobe as well as certain areas of the deeper brain.
Impulsivity may drop towards adulthood as well as hyperactivity as the frontal lobe develops. Many young girls don’t show hyperactivity at all, they sit very quietly as their mind wanders.
Co-morbidity (problems with substance abuse, with the law, marriages and jobs) increases over time. So anyone who presents with depression, substance abuse, anxiety, needs to be screened for ADHD and Bipolar disorder.