When a child is diagnosed with attention-deficit hyperactivity disorder (ADHD), they may be at risk for developing other mental health-related disorders in adulthood. These can include anxiety disorders, major depression, and bipolar disorder. While researchers have much to learn about the neurobiological interaction between the two disorders, they have estimated that anywhere from 9% to 35% of adults with bipolar disorder also have ADHD.

Many people with bipolar disorder may find that even when their mood is stabilized with the right medication and treatment, they still struggle to meet deadlines, keep their focus on a task, and stay organized. Often, they mentally beat themselves up for not being motivated enough to change their behaviors. In these cases, ADHD may be the culprit, and by seeking treatment for both disorders, they can gain better control over their thoughts, emotions, and behaviors as well as improve their personal lives.

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Adult ADHD symptoms can include the following:2

• Trouble focusing on a task
• Feelings of restlessness
• Organization problems
• Feeling easily frustrated
• Poor time management
• Impulsive decision-making
• Poor coping skills for stress

Distinguishing Between the Disorders

There is somewhat of an overlap between symptoms of ADHD and mania or hypomania associated with bipolar disorder. These can include distractibility, talkativeness, difficulty maintaining attention, and loss of social functioning. Doctors may use several criteria to determine the difference between ADHD and bipolar disorder or assess whether the disorders are co-occurring. Good indications of ADHD can include the onset of ADHD symptoms at an early age and continuity of symptoms in the absence of a depressive, manic, or hypomanic episode.3 Similarly, if symptoms are cyclical, and there is an increase in goal-directed activity, an inflated sense of self, and a decreased need for sleep, then a person may be experiencing a manic or hypomanic episode rather than, or in addition to, ADHD.4

Here are some example questions your doctor may ask you to diagnose ADHD in addition to bipolar disorder:

• Have you experienced symptoms of hyperactivity, impulsivity, or inattention since childhood?
• Do you currently struggle with inattention or impulsivity when your mood is otherwise stable?
• Are there other environmental stressors that might contribute to these symptoms?
• Are there other medical or psychiatric conditions that might contribute to these symptoms?
• Have symptoms interfered with your work, relationships, or other daily functioning?

In order to accurately diagnose ADHD and/or bipolar disorder, your doctor will need to rule out other potential diagnoses that may cause symptoms. These can include sleep disorders, head injury, other physical illness, anxiety disorders, major depression, personality disorders, the effects of medication, and the effects of substance use.5 They may also need to rule out environmental and situational stressors that can produce symptoms.

Children with ADHD and Bipolar Disorder

Although symptoms of bipolar disorder typically don’t emerge until early adulthood, children can receive a diagnosis. A child with both ADHD and bipolar disorder will have behavioral outbursts, experience severe mood swings, and act impulsively. If your child with ADHD exhibits an inflated sense of self, demonstrates risky sexual behavior, engages in self-harm, and has little need for sleep, then he or she also may be experiencing mania associated with bipolar disorder.6 A child psychiatrist can help rule out other diagnoses and suggest treatment options.

Treatment Considerations

A co-occurring diagnosis of ADHD and bipolar disorder can put people at higher risk for substance use, relationship problems, suicidal behaviors, and legal problems.7 Therefore, early and comprehensive treatment is essential for healthy functioning. Because the effects of bipolar disorder are more severe if left untreated, treatment considerations typically involve stabilizing your mood before treating the symptoms of ADHD. This often involves a combination of medication, therapy, and education. Treatment also may include psychoeducation about healthy coping and the dangers of substance use, as people with ADHD and bipolar disorder are at much higher risk for a substance use disorder.

Because roughly 65% of people with ADHD and Bipolar disorder will experience an anxiety disorder in their lifetime, a doctor or mental health professional may recommend treatment for anxiety as well.8 Researchers don’t completely understand the effects of stimulants on bipolar disorder, but some studies show that stimulants used to treat ADHD can increase anxiety or agitation and induce mania.9 Medications that treat bipolar disorder, however, are unlikely to exacerbate the symptoms of ADHD.10 Talk to your doctor about the risks and benefits and what signs and symptoms you should report immediately when taking medication.

If you think you might have a diagnosis of ADHD in addition to bipolar disorder, make an appointment with your doctor to talk about your concerns. They may refer you to a mental health professional for a more thorough assessment. It’s important to remember that your symptoms are not a failure on your part, so don’t be afraid to speak up about your struggles. The more accurately you can report signs and symptoms, the greater chance you have of treating them. Seeking treatment greatly increases your odds of thriving in the midst of life’s challenges, so consider what steps you can take today to get the right information and the best support.

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Last Updated: Nov 20, 2017