Distinguishing Bipolar from ADHD

May 16, 2011
A reader asked:

What is the best method for distinguishing a non-extreme case of bipolar disorder from ADHD? My 12 year old daughter is diagnosed as ADHD, and is on Adderall which is somewhat helpfull. We have a maternal family history of bipolar II (mom) and I (grandmom). My daughter is displaying some bipolar symptoms, but nothing extreme. Our phsychiatrist is considering bipolar in addition to or instead of ADHD. He is considering adding Lamictal to Adderal or replacing Adderall with Lamictal, and suggested that her response to therapy may be the tie breaker in her diagnosis. Is this the best approach?

Dr. Dave:

Good question. The family history of bipolar does raise the question of whether the ADHD symptoms you're seeing are in fact mood symptoms. Many symptoms- hyperactivity, distractibility, pressure of speech - are seen in both disorders. Often we have to follow kids over time to see which one they have, but many kids (up to 60% in some studies) are diagnosed with both disorders.

The treatment is usually a combination of mood stabilizers plus stimulants like Adderall. The problem with switching from lamictal to adderrall is that you are essentially making two changes at once- stopping Adderall and adding Lamictal. It's probably better to gradually add Lamictal and see if you get better mood stabilization. Then, if she's doing better, you can consider tapering off the Adderall and seeing if she remains stable. But many kids need both.

Diagnoses should not be made based on which medications the kid responds to. Unfortunately, we often don't have other information. I'd suggest keeping a daily mood chart on your daughter charting her ups and downs. Google "mood diary" or "mood chart" and you'll see several options.