A reader asked:
My friend's daughter is 15 and was rather recently diagnosed with Bipolar 1. She also appears to have symptoms of ADD , unable to complete even simple tasks, forgetful,loses things, dreamy etc. Is it common to find Bipolar in combination with Add. Are there any articles or publications regarding this subject. I would be very thankful for more information.
Yes, the co-ocurrence of ADHD occurs in between 60% and 90% of kids with bipolar disorder. The symptoms you mention, like being disorganized, forgetting, distractibility, etc can occur in bipolar kids even when they don't have major mood symptoms. It can be hard to tell the two disorders apart during mania or hypomania, because an increase in energy and motor activity or pressure of speech can be a feature of either disorder. Look for Barbara Geller's edited book with Melissa Delbello on Bipolar Disorder in Children and Adolescents. I also have a section on this topic in "The Bipolar teen."
It is usually recommended that medications are used to stabilize the mania symptoms before treating the ADHD symptoms, since starting off with a stimulant may worsen a manic state. But many kids are treated with combinations of mood stabilizers like lithium and stimulants like Ritalin or Adderall. It's a good idea to keep a daily or weekly mood chart so you can graph the ups and downs of the mood disorder to see if the ADHD symptoms persist wven when the kid is feeling well.