Co-morbidity of bipolar disorder in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in an outpatient Turkish sample

Abstract

This study aimed to assess the prevalence of bipolar disorder (BPD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to compare the clinical characteristics of a group with ADHD with a group with co-morbidity of ADHD and BPD. The study includes 121 individuals, aged 6-16 years, with a diagnosis of ADHD. Co-morbidity of BPD was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL) and the Parent-Young Mania Rating Scale (P-YMRS). The Child Behavior Checklist (CBCL) was used to assess psychopathology in two groups. Ten children (8.3%) in the ADHD sample received the additional diagnosis of BPD. The ADHD + BPD group had significantly higher scores than the ADHD group on withdrawn, anxiety/depression, social problems, thought problems, attention problems, aggression, externalization, total score items of CBCL, and on the P-YMRS. It could be concluded that BPD is not a rare co-morbid condition in children with diagnosis of ADHD and subjects with this co-morbidity show more severe psychopathology than subjects with pure ADHD. Differential diagnosis of BPD disorder in subjects with ADHD seems crucial in establishing an effective treatment program, and therefore improving mental health outcomes.

Further evidence that pediatric-onset bipolar disorder comorbid with ADHD represents a distinct subtype: Results from a large controlled family study

“…Similar findings were reported by Lus and Mukaddes (2009) who found that 8.3% of a sample of 121 youth 6–16 years with ADHD also met diagnostic criteria for bipolar disorder and that those affected with this comorbidity had significantly more pathological scores on multiple CBCL scales and on the YMRS than other ADHD youth without this comorbidity. Bernardi et al (2010) identified a rate of co-occurrence of ADHD with bipolar disorder of 18% lifetime and 10% current in a sample of 100 adult bipolar outpatients aged 18–30 years.…”

“…A bidirectional and robust comorbidity between pediatric bipolar (BP)-I disorder and attention deficit hyperactivity (ADHD) has been well documented in pediatric and adult studies in both clinical and epidemiological samples (Biederman et al 2001; Kessler et al 2006; Singh et al 2006; Lus & Mukaddes 2009; Arnold et al 2011). Arnold et al (2011) examined the comorbidity between ADHD and bipolar spectrum disorders (BPSDs) in the Longitudinal Assessment of Manic Symptoms (LAMS) study.…”

Examining the Comorbidity Between Attention Deficit Hyperactivity Disorder and Bipolar I Disorder: A Meta-Analysis of Family Genetic Studies

“…Significantly elevated rates of bipolar I disorder have also been reported in studies of youths with ADHD (12)(13)(14)(15), and this comorbidity has been confirmed in studies of adults with bipolar disorder and ADHD. Sachs et al (16) found significant ADHD comorbidity in adults with an onset of bipolar I disorder before age 19, but not for those with older ages at onset.…”

“…As our pooled analysis of the Massachusetts General Hospital data sets showed, this prediction was rejected. Moreover, if ADHD and bipolar I are a unitary disorder, then rates of comorbidity should be the same regardless of whether they are estimated from samples ascertained for ADHD or bipolar I disorder, yet the rates are much higher for the latter method of ascertainment (11)(12)(13)(14)29). Finally, the idea that the two disorders are the same suggests that the treatments of the two disorders would be the same, which is not the case (25,73,74).…”

Pattern of child and adolescent psychiatric disorders among patients consulting publicly-funded child psychiatric clinics in Saudi Arabia

“…Notably there is a huge research database in the industrialized countries that assists in the development of good quality health care services for children and adolescents [5][6][7][8][9][10]. Most of the studies reported externalizing disorders such as attention deficit hyperactivity disorder (ADHD) as the most common, followed by internal disorders such as depression and anxiety plus co-occurrence of internal and external disorders [11][12][13][14][15][16]. Overall childhood psychopathology is the harbinger of similar (homotypic) or dissimilar (heterotypic) adult psychopathology.…”