Oct. 29, 2002 (San Francisco) -- Distractibility, hyperactivity, and talkativeness are all hallmark signs of attention deficit hyperactivity disorder (ADHD), as any parent of a child with ADHD can tell you. In a minority of children, though, they can also be signs of childhood-onset bipolar disorder.
A new study presented at the American Academy of Child and Adolescent Psychiatry shows that a child can have both disorders and that simultaneous ADHD and bipolar disorder in a child may be a distinct disorder, according to Janet Wozniak, MD, who presented the study. Furthermore, because ADHD is more common than bipolar disorder, the latter diagnosis may be overlooked.
Therefore, when parents take a child with ADHD for treatment, they would be wise to share any family history of bipolar disorder with the doctor, said Wozniak, assistant professor of psychiatry at Harvard Medical School in Boston, where she directs bipolar disorder research in the pediatric psychopharmacology department at Massachusetts General Hospital.
"If a child with ADHD has an undiagnosed bipolar disorder as well, conventional ADHD therapy can worsen the bipolar disorder," she tells WebMD. The typical therapy for ADHD is a stimulant such as Ritalin or Adderall.
"The good news is that if the child also has bipolar disorder, we can treat those symptoms first with a mood-stabilizing medication," she says. "Then if we treat any remaining ADHD symptoms with a stimulant, the child will typically be fine on the combined medications."
Wozniak's group wanted to know if there was a familial association of ADHD and bipolar disorder among parents and siblings of young people with bipolar disorder.
The investigators conducted interviews with 189 parents and siblings of 69 children who had bipolar disorder. They compared the data on these children and their relatives with similar information on the relatives of children with ADHD but without bipolar disorder, and with information on children who did not have either disorder.
They found that of the children that had bipolar disorder, 14% of the relatives had bipolar disorder and 20% had ADHD. Among the children with only ADHD, 4% of the relatives had bipolar disorder and 19% had ADHD. Among the children free of either disorder, only 3% of the relatives had bipolar disorder and only 5% had ADHD.
"Many parents of children with bipolar disorder know that the illness 'runs in the family,' and these data confirm their suspicions," Barbara Geller, MD, who was not involved in the research, tells WebMD. "You are more likely to have a family with bipolar disorder if the child has the condition. This also confirms the suspicions of many physicians. If they see children with bipolar disorder, they are likely to be members of families where others also have the illness." Geller is a professor of psychiatry at Washington University in St. Louis.
Parents may have a hard time telling a doctor that their child has bipolar disorder since the childhood-onset version of the condition is a relatively new diagnosis. However, she urged parents to bring their concerns to their doctor and to mention any relatives that have bipolar disorder. "If it's in the family, the doctor will want to be alert that the child may have bipolar disorder, so that he or she can receive the proper medication," she says.