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It is normal for children to switch from feeling happy to sad. But for some children, changes in mood can be severe and persistent. Bipolar disorder causes extreme changes in energy, activity level, and concentration. These quick facts will help you: 

1. Spot the symptoms of bipolar disorder in your child with ADHD 
2. Know what to do if you feel your child with ADHD may have bipolar disorder 
3. Learn how your child’s doctor will diagnose and treat both bipolar disorder and ADHD 

What are the signs and symptoms of bipolar disorder?  

The main symptom of bipolar disorder is severe mood swings, also called episodes. The main types of bipolar episodes are called manic, depressive, and mixed.  

Manic episodes in children may include: 

• Feeling full of energy, “up,” or “high” 
• Intense irritability  
• Increased impulsive behaviors 
• Not requiring sleep 
• Racing thoughts  
• Exaggerated beliefs about their skills, knowledge, and abilities  

Depressive episodes in children may include: 

• Feeling unusually sad or down, hopeless, and numb 
• Sleeping too much or having a hard time falling asleep  
• Difficulty completing tasks or making decisions 
• No longer interested in activities that they previously enjoyed 
• Suicidal thoughts 

Mixed episodes include symptoms of both manic and depressive episodes. 

How common is bipolar disorder in children with ADHD? 

About one out of five children with ADHD are diagnosed with bipolar disorder [11]. On the other hand, three out of four children diagnosed with bipolar disorder also have ADHD [11,12,13].  

What causes bipolar disorder? 

There is no known cause of bipolar disorder, but researchers have found that a child is more likely to have the disorder if someone in their immediate family has it [9][15], especially if they are also exposed to trauma or stressful life events [15]. 

Strategies for helping your child with ADHD and bipolar disorder 

You can take the following steps if you think your child with ADHD may have bipolar disorder: 

• Create a caring home where your child feels comfortable sharing how they feel with you. Listen to what your child says. [15] 

• Keep your face, voice, and body calm. Be reassuring and hopeful. Show your child how you cope with mood swings. Children learn by watching the behaviors of those around them.  

• Pay close attention to your child’s moods and behaviors, especially to large changes  

• Let your child’s doctor know about any new symptoms or changes in mood. [15]. When ADHD is not treated, it can make bipolar disorder symptoms worse. 

• Keep track of times or places that may trigger strong emotions and plan together ways your child can manage them. 

• Talk to your child about questions they have about ADHD and bipolar disorder treatment and how it can help them.  

• Seek support if you are overwhelmed.  

Diagnosis  

ADHD and bipolar disorder share common symptoms, such as impulsivity, hyperactivity, and mood swings, which can make a diagnosis challenging [8]. Signs of ADHD may begin earlier than bipolar disorder.  When a child has both conditions, both types of symptoms tend to show up by the teenage years.  

A healthcare professional who is trained in the diagnosis of both bipolar disorder and ADHD will examine how and when symptoms are present. They may do a physical exam and order lab tests to rule out other conditions such as thyroid disorder that can have similar symptoms. They may ask about a child or teen’s medical history [3].  

When diagnosing bipolar disorder, they may also include a mental health evaluation. The doctor may ask older teens to complete a self-rating scale. However, some teens may find it difficult to describe symptoms or remember when their symptoms first began. If this happens, the doctor may rely on parent interviews instead. 

Treatment  

Bipolar disorder can be treated with psychotherapy and medication.  When making a treatment plan, the doctor will look at how severe the bipolar symptoms are, as well as the child or teen’s thinking ability, emotional maturity, and developmental level [9].  

Non-medication treatment for children with bipolar disorder may include: 

• Family skill building plus psychoeducation 

• Dialectical behavior therapy 

Medication may be used to treat individuals with both bipolar disorder and ADHD, but it needs to be carefully chosen and watched by a medical professional because of possible side effects. Medications that are helpful for ADHD symptoms, such as stimulants, can cause changes in mood and sleep for children and teens who have bipolar disorder [9]. If stimulant medication causes a manic episode, parents should talk to their child’s doctor about stopping the medication. 

Non-medication treatment for children with ADHD may include: 

• Parent and family behavioral training 

• Cognitive Behavioral therapy (for teens and young adults) 

References 

1. AAP. Mood Disorders & ADHD.  
2. CHADD. ADHD and Coexisting Conditions (infographic).  
3. CHADD. Evaluating for Childhood ADHD.  
4. CHADD. ADHD Can Increase Risk of Suicide.  
5. Medline Plus. Bipolar Disorder.  
6. NIMH. Bipolar Disorder.  
7. NAMI. Bipolar Disorder.  
8. Donfrancesco, R. et al. (2017). Bipolar Disorder in Children with ADHD: A Clinical Sample Study. Journal of Attention Disorders, 21(9), 715–720.  
9. Sadek, J. (2019). ADHD and Bipolar Disorder. In J. Sadek (Ed.), Clinician’s Guide to ADHD Comorbidities in Children and Adolescents: Case Studies (pp. 99–107). Springer International Publishing.  
10. Bond, D. J. et al. (2012). The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Annals of Clinical Psychiatry, 24(1), 23–37.  
11. Biederman, Joseph L. ADHD and Bipolar Disorder in Children. February 14, 2016.  
12. McGovern Medical School. ADHD vs. Bipolar: Diagnosing the Difference in Kids. August 3, 2018.  
13. Arnold LE et al. Pediatric bipolar spectrum disorder and ADHD: comparison and comorbidity in the LAMS clinical sample. Bipolar Disorders 2011: 13: 509–521.  
14. Arnold LE et al. Pediatric bipolar disorder and ADHD: Family history comparison in the LAMS clinical sample. J Affect Disord. 2012 Dec 10;141(2-3):382. 
15. National Institute of Mental Health. (2023). Bipolar Disorder in Children and Teens. 
16. Mental Health America. (2023). Bipolar Disorder.