Bipolar and ADHD Comorbidity: Both Artifact and Outgrowth of Shared Mechanisms

University of North Carolina at Chapel Hill.
Clinical Psychology Science and Practice (Impact Factor: 2.92). 12/2010; 17(4):350-359. DOI: 10.1111/j.1468-2850.2010.01226.x
Source: PubMed


[Clin Psychol Sci Prac 17: 350–359, 2010]
Published rates of comorbidity between pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) have been higher than would be expected if they were independent conditions, but also dramatically different across different studies. This review examines processes that could artificially create the appearance of comorbidity or substantially bias estimates of the PBD-ADHD comorbidity rate, including categorization of dimensional constructs, overlap among diagnostic criteria, over-splitting, developmental sequencing, and referral or surveillance biases. Evidence also suggests some mechanisms for “true” PBD-ADHD comorbidity, including shared risk factors, distinct subtypes, and weak causal relationships. Keys to differential diagnosis include focusing on episodic presentation and nonoverlapping symptoms unique to mania.

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    • "However, the exclusion of cases with comorbid mood disorder might have resulted in the ADHD group in Geller et al. being higher functioning than other ADHD samples with mood comorbidity. Certainly, moodiness and irritability are common associated features of ADHD, and unipolar depression is a frequent comorbidity among cases with ADHD (Youngstrom et al. 2010). Two additional studies have found psychosocial impairment in youth with PBD compared to youth with other psychopathology. "
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    ABSTRACT: Background Pediatric bipolar disorder (PBD) is associated with psychosocial impairment, but few studies have examined peer relationship functioning and PBD. Adolescence is a crucial developmental period when peers become increasingly salient. Objective This study compared perceived friendship quality and peer victimization in adolescents with PBD to external community benchmarks and to adolescents with other psychopathology. We also measured the association between peer difficulties and current mood symptoms across diagnoses. Methods Participants were 189 adolescents, ages 10–17 years (46 % female; 58 % African American, 32 % Caucasian, 10 % Other), recruited from a community mental health center (n = 73) and an academic medical center (n = 116). Diagnoses were made via semi-structured diagnostic interviews. Adolescents completed questionnaires to assess peer relationship functioning and mood symptoms. Caregivers completed a questionnaire to assess adolescents’ mood symptoms. Results Adolescents with PBD reported significantly fewer positive and negative qualities in a close friendship and more relational victimization than external community controls. There were no significant differences between adolescents with PBD and those with other psychopathology. Depression and (hypo)mania were both associated with more negative friendship quality and peer victimization. Conclusions Adolescents with psychiatric disorders reported more peer difficulties than an external community sample, but difficulties were not specific to PBD. Mood symptoms were problematic for perceived close friendship quality and peer victimization in youth with a variety of psychiatric diagnoses. Results suggest that treatments targeting mood symptoms may improve peer relationships and those with an interpersonal focus may be particularly helpful to address mood symptoms.
    Full-text · Article · Jun 2015 · Child and Youth Care Forum
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    • "Meta-analyses of PBD studies have found an average of 62% also meeting criteria for ADHD (Youngstrom et al., 2010). There is a flourishing literature on the question of whether ADHD comorbidity impacts the neurocognitive profile of PBD youth. "
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    ABSTRACT: Background Pediatric bipolar disorder (PBD) has emerged as a field of research in which neuropsychological studies are continuously providing new empirical findings. Despite this, a comprehensive framework for neurocognitive impairments is still lacking, and most of the evidence remains unconnected. We addressed this question through a systematic review of neuropsychological research, with the aim of elucidating the main issues concerning this topic. Method A comprehensive search of databases (PubMed, PsycINFO) was performed. Published manuscripts between 1990 and January 2014 were identified. Overall, 124 studies fulfilled inclusion criteria. Methodological differences between studies required a descriptive review of findings. Results Evidence indicates that verbal/visual-spatial memory, processing speed, working memory, and social cognition are neurocognitive domains impaired in PBD youth. Furthermore, these deficits are greater among those who suffer acute affective symptoms, PBD type I, and/or attention deficit hyperactivity disorder (ADHD) comorbidity. In addition, several neurocognitive deficits imply certain changes in prefrontal cortex activity and are somewhat associated with psychosocial and academic disabilities. Strikingly, these deficits are consistently similar to those encountered in ADHD as well as severe mood dysregulation (SMD). Besides, some neurocognitive impairments appear before the onset of the illness and tend to maintain stable across adolescence. Finally, any therapy has not yet demonstrated to be effective on diminishing these neurocognitive impairments. Limitations More prolonged follow-up studies aimed at delineating the course of treatment and the response to it are warranted. Conclusions Despite noteworthy research on the neurocognitive profile of PBD, our knowledge is still lagging behind evidence from adult counterparts.
    Full-text · Article · Sep 2014 · Journal of Affective Disorders
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    ABSTRACT:   To compare attention-deficit hyperactivity disorder (ADHD), bipolar spectrum disorders (BPSDs), and comorbidity in the Longitudinal Assessment of Manic Symptoms (LAMS) study.   Children ages 6-12 were recruited at first visit to clinics associated with four universities. A BPSD diagnosis required that the patient exhibit episodes. Four hypotheses were tested: (i) children with BPSD + ADHD would have a younger age of mood symptom onset than those with BPSD but no ADHD; (ii) children with BPSD + ADHD would have more severe ADHD and BPSD symptoms than those with only one disorder; (iii) global functioning would be more impaired in children with ADHD + BPSD than in children with either diagnosis alone; and (iv) the ADHD + BPSD group would have more additional diagnoses.   Of 707 children, 421 had ADHD alone, 45 had BPSD alone, 117 had both ADHD and BPSD, and 124 had neither. Comorbidity (16.5%) was slightly less than expected by chance (17.5%). Age of mood symptom onset was not different between the BPSD + ADHD group and the BPSD-alone group. Symptom severity increased and global functioning decreased with comorbidity. Comorbidity with other disorders was highest for the ADHD + BPSD group, but higher for the ADHD-alone than the BPSD-alone group. Children with BPSD were four times as likely to be hospitalized (22%) as children with ADHD alone.   The high rate of BPSD in ADHD reported by some authors may be better explained as a high rate of both disorders in child outpatient settings rather than ADHD being a risk factor for BPSD. Co-occurrence of the two disorders is associated with poorer global functioning, greater symptom severity, and more additional comorbidity than for either single disorder.
    Full-text · Article · Aug 2011 · Bipolar Disorders
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