Writers Offer Guidance to Untangling ADHD, Bipolar Disorder Diagnoses
> 6/21/2007 9:55:24 AM

Although it is typically thought of and discussed as a disorder that affects children, approximately 4.4% of adult Americans struggle with attention deficit hyperactivity disorder (ADHD). Because it can present with symptoms similar to other disorders and has high levels of comorbidity, ADHD is particularly difficult to diagnosis in adults. In an article published in the June 2007 issue of, Current Psychiatry, two writers tackle this difficult topic by examining the issue of ADHD comorbidity with bipolar disorder.

As the writers point out, 9 to 12% of patients who have a bipolar diagnosis may also have adult ADHD. Likewise, studies have found that anywhere from 5 to 47% of adult ADHD sufferers may be bipolar. The challenge in identifying one or both of these disorders, however, is that they share many of the same diagnostic criteria. Talkativeness, distractibility, increased physical activity, and loss of social inhibitions are some of the symptoms of ADHD and bipolar mania.

As the writers note in Current Psychiatry, there is a clinical pattern that must be adhered to so as to appropriately diagnose these seemingly intertwined disorders:

A diagnostic hierarchy is implicit in DSM-IV-TR; anxiety disorders are not diagnosed during an active major depressive or manic episode, and schizophrenia is not diagnosed on the basis of psychotic symptoms during an active major depressive or manic episode. Mood disorders sit atop this implied diagnostic hierarchy and must be ruled out before psychotic or anxiety disorders are diagnosed. Similarly, most personality disorders are not diagnosed during an active mood or psychotic episode.

The danger of a rush to judgment in any one direction is that the wrong treatment for a false negative of bipolar could accelerate the peaks and valleys of the bipolar client, while a false positive could place undue stress on an ADHD client. By addressing any mood disorders first, as they point out, a physician will better be able to observe symptoms of ADHD and treat accordingly.

In their article, the writers present a number of schemes for successfully handling a client that presents with symptoms that indicate ADHD or bipolar. But as they point out, even for the most highly skilled mental health practitioner, this can be a challenge. For any individuals who feel that they might be suffering with either or both of these disorders, the best option is finding a qualified medical practitioner who can accurately diagnose the disorder and provide the appropriate treatment. In this case, both parties need to be cautious and patient. Keeping an open dialogue about changes in mood and symptoms will help to prevent any possible negative outcomes.

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