Attention‐deficit hyperactivity disorder – bipolar comorbidity in children and adolescents

Objective:  A substantial portion of juvenile bipolar disorder (BD) has a comorbid attention‐deficit hyperactivity disorder (ADHD). The aim of our study was to analyze the cross‐sectional and longitudinal implications of such comorbidity in children and adolescents with BD. Methods:  Ninety‐eight refereed patients (mean age 13.7 ± 3.0 years) with a diagnosis of BD by the Schedule for Affective Disorders and Schizophrenia for School‐Age Children, Present and Lifetime version (K‐SADS‐PL) were followed for 6 months. Results:  Thirty‐seven BD patients (37.8%) presented a lifetime diagnosis of comorbid ADHD. The mean age of onset of ADHD was 3.7 ± 1.1 years, and the mean age of onset of BD was 10.0 ± 3.2 years. Bipolar subjects with comorbid ADHD were predominantly male, younger, and had an earlier onset of BD (8.1 ±  2.8 versus 11.1 ± 2.9 years). Bipolar‐ADHD patients presented more frequently a chronic rather than an episodic course of BD, with an irritable rather than an elated mood. They showed higher rates of oppositional defiant disorder/conduct disorder, lower rates of panic disorder, and less frequently received antidepressant medications. Finally, ADHD comorbidity was associated with a greater psychosocial impairment. Conclusions:  ADHD comorbidity is frequent in juvenile BD and can influence age of onset, phenomenology, comorbidity, and course of BD. A timely diagnosis should improve our efforts regarding the outcome of these subjects.