Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

Abstract

World Journal of Psychiatry W J P Retrospective Study ORIGINAL ARTICLEorted significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ 2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001). CONCLUSION:Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.Key words: Multimodal treatment study of attention deficit hyperactivity disorder; Irritability; Attention deficit hyperactivity disorder; Diagnostic interview schedule for children; Bipolar disorder Core tip: Despite its formal DSM delineation, alternative pediatric bipolar disorder (BD) definitions have been debated for decades. Some research suggests that attention deficit hyperactivity disorder (ADHD) poses a risk for BD and that pediatric BD presents differently as non-episodic, greater chronicity, and more frequent irritability. In our study, we found the ADHD status is not a risk factor for developing BD over 14 years of followups. When we controlled for overlapping ADHD/BD, nonspecific symptoms showed decreasing rates of BD in ADHD-diagnosed children. Clinicians are encouraged to pay greater attention to specific symptoms of mania in order to establish an accurate BD diagnosis. Furthermore, irritability (DSM criteria A2), was a nonspecific symptom of mania and linked to common psychopathologies in the early development of these children.

A Longitudinal Study of Psychiatric Disorders in Offspring of Parents With Bipolar Disorder From Preschool to Adolescence

“…However, results from such studies are inconsistent. 2,44,45 For example, the Multimodal Treatment Study did not find that ADHD is associated with increased risk for developing BD but that it is associated with the development of some manic symptoms. 45 In contrast, a recent longitudinal study reported higher incidence rates of BD among individuals with history of ADHD.…”

“…2,44,45 For example, the Multimodal Treatment Study did not find that ADHD is associated with increased risk for developing BD but that it is associated with the development of some manic symptoms. 45 In contrast, a recent longitudinal study reported higher incidence rates of BD among individuals with history of ADHD. 46 Also, a study of 13,532 twin pairs (9À12 years of age) found that ADHD and hypomanic symptoms were associated with shared genetic factors.…”

Long‐term outcomes for children with neurodevelopmental disorders: Are they core business for paediatricians?

“…11 This situation is further complicated by cumulative maladaptive consequences across a diverse range of outcome areas, including in education, mental health, social dysfunction, vocational underachievement and crime. [23][24][25][26][27][28][29][30] From this group comparison and longitudinal data, it is reasonable to draw a number of conclusions. The first is that underlying biological aetiology probably persists in some form for a significant proportion of children with NB problems.…”

“…Multiple studies suggest that clinical challenges persist in many, perhaps the majority, of cases even if the profile of problems changes with time and developmental circumstances . This situation is further complicated by cumulative maladaptive consequences across a diverse range of outcome areas, including in education, mental health, social dysfunction, vocational underachievement and crime …”

Comparative Evaluation of Child Behavior Checklist-Derived Scales in Children Clinically Referred for Emotional and Behavioral Dysregulation

“…Yet, the task of developing instruments for the assessment of psychiatric conditions in children is challenging because of high comorbidity ( 1 – 3 ) and significant overlap in clinical features ( 2 ). Our group has a long-standing interest in childhood emotional and cognitive dysregulation and its relevance to the formal diagnostic categories of attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) ( 4 – 7 ). This motivates research into developing instruments for the assessment of childhood behavioral problems that can be easily used in research and clinical care.…”