Is It ADHD or Bipolar Disorder?

When Alex Raeburn was in the fourth grade, he started having discipline problems and occasional outbursts in school. Toward the end of his fifth grade year, he stormed out of the classroom, broke the glass face of a hall clock, then left the school building entirely. The incident landed him in the psychiatric ward of a hospital where he underwent testing, but he left without a diagnosis.

Alex's problems continued, so his parents took him to see a psychiatrist who had been recommended by his school's psychologist. "This doctor talked to my wife and I for 15 minutes, then to Alex for 15 minutes, diagnosed him with ADHD (attention deficit hyperactivity disorder) and put him on Ritalin," says Paul Raeburn, who wrote a book about his son's experiences entitled Acquainted with the Night. When there was no improvement after a few weeks on the medication, the doctor suggested increasing Alex's dose.

"After we increased the dose, Alex became completely out of control, very volatile and angry," Raeburn tells WebMD. "He threatened to run out of the house and not come back, so we had to hospitalize him again."

It was during this hospital stay that bipolar disorder was first suggested as a possible diagnosis instead of ADHD. Eventually, it was confirmed that Alex indeed suffered from bipolar disorder and that the Ritalin had most likely triggered his violent episode.

Because ADHD and bipolar disorder do share some symptoms and sometimes coexist, children like Alex are commonly misdiagnosed. ADHD is a more common condition in children and often the first thing a doctor thinks of.

"One problem is that there are not many child psychiatrists in this country, so parents take their child to a pediatrician, who just isn't equipped to do a comprehensive assessment, says J. Kim Penberthy, PhD, a professor in the department of psychiatric medicine at the University of Virginia. "Instead, a quick and dirty job of diagnosing is done."

According to the National Institute of Mental Health, bipolar disorder is difficult to recognize and diagnose in youths because it does not fit typical symptoms seen for adults.

Research done by Joseph Biederman, MD, a child psychiatrist and expert in bipolar disorder in children, estimates the frequency of ADHD in school-aged kids at 3%-5%. The frequency of bipolar disorder in the same group is estimated to be less than half of 1%. Most of the children diagnosed with bipolar disorder also meet the criteria for ADHD, while only about one in five with ADHD meet bipolar disorder criteria.

Some experts believe that ADHD is overdiagnosed, and while bipolar disorder is relatively rare in children, it tends to be underdiagnosed. This could be because bipolar disorder typically surfaces in adolescence or early adulthood, and it is much less black-and-white in terms of how it manifests in children.