Disentangling ADHD and Bipolar Disorder in adult women
By Georgia Kydoniea and Stella Spyridi

Delineating ADHD and bipolar disorder: A comparison of clinical profiles in adult women

By Glenn L Kitsune, Jonna Kuntsi, Helen Costello, Sophia Frangou, Georgina M Hosang, Gráinne McLoughlin, Philip Asherson

Abstract:
Objective: Overlapping symptoms can make the diagnostic differentiation of attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) challenging in adults using current clinical assessments. This study sought to determine if current clinical measures delineate ADHD from BD in adults, comparing relative levels of ADHD, BD and emotional lability (EL) symptoms.

Methods:
Sixty adult women with ADHD, BD or controls were compared on self-report and interview measures for ADHD symptoms, mania, depression, EL, and impairment.

Results:
ADHD interview measures and self-ratings of ADHD symptoms best discriminated between ADHD and BD. Self-report measures of EL and depression showed non-specific enhancement in both clinical groups. BD-specific items may distinguish BD from ADHD if a retrospective time-frame is adopted.

Conclusions:
Using measures which capture specific symptoms of ADHD and chronicity/episodicity of symptoms facilitates the delineation of ADHD from BD in adult women.

Short comment
ADHD and Bipolar Disorder, are two different disorders with similar presentation such as restlessness, increased production of speech and distractibility that can make differentiation of the two conditions very challenging. The co-morbidity between the two disorders, makes it even more difficult to distinguish between ADHD and BD, as there is little research on people with ADHD symptoms in their adult life. Furthermore, the authors hypothesise that women with ADHD will present with a significant number of mania-like symptoms due to the overlap in symptom criteria.

This study, based on common measures used in the diagnostic evaluation of ADHD and BD, compared and contrasted female patients with typical ADHD, female patients with Bipolar I Disorder (who were not currently suffering a manic episode), and healthy controls. Increased levels of ADHD and depressive symptoms, emotional lability, and functional impairment were observed in both the ADHD and BD groups compared to controls when using ratings for the current mental state. In general, the ADHD group displayed higher psychopathology scores compared to the BD group, especially for current manifestations of emotional lability and mania. Although both groups obtained greater ratings than the control group, the BD group received higher scores for mania in the YMRS, when this scale was used to retrospectively evaluate previous manic episodes.

The distinction between ADHD and BD disorder is crucial, because individuals with BD frequently exhibit ongoing mood symptoms and functional limitations between acute emotional episodes, raising the question of whether any observed psychopathology is caused by BD’s persistence or could be caused by comorbid ADHD. In fact, this study’s use of both rating scale and interview assessments revealed significant overlap between BD and ADHD.

However, in studies like this, the samples are commonly small and comprise from female participants only with typical ADHD, typical BD-I, and healthy controls. Therefore, it is unclear to what degree these results can be generalised to more complicated patients of both sexes who exhibit traits of both BD and ADHD.

Overall, ADHD is a chronic and impairing condition with a high level of EL and hyperactivity that could be mistaken for mania symptoms. The best tests for differentiating ADHD from BD in adult women are those like the DIVA interview, which combine a detailed disorder-specific description of ADHD symptoms with a temporal component. This can capture the distinction between sustained traits and episodic symptoms that reflect a change in the pre-morbid mental state. The authors drew the conclusion that, in contrast to rating scale data, interview measurements combined with a developmental description of symptoms and deficits offer strong differentiation and ought to always be employed as the main diagnostic tool in the assessment of ADHD and Bipolar Disorder.