Keys to Distinguishing ADHD From Bipolar Disorder in Adults

A psychologist refers numerous patients with the diagnosis of adult attentiondeficit hyperactivity disorder (ADHD) to me for prescriptions for extended-releasemethylphenidate. There has been no psychiatric evaluation. To help mefeel more confident prescribing this medication in such a setting, can you describethe characteristics that distinguish adult ADHD from bipolar disorder?
- Rosemary Selinger, MD
   Grants Pass, OreIt is imperative for any physician asked to prescribe for a psychologist toensure adequate workup of the condition, be it ADHD, major depressivedisorder, bipolar disorder, anxiety, or any other disorder. In part, validationdepends on the physician's familiarity with the psychologist. However,in instances where such confidence has not developed, it is wise to dothe following:1. Take a brief ADHD inventory (which should take about 10 minutes).The distinguishing features of adult ADHD are:

• Either inattention, hyperactivity/impulsivity, or both-verified with anadult screening tool to confirm a sufficient level of symptoms. An adultADHD self-report scale, such as the one developed by the World HealthOrganization,¹ is very useful here.
• Symptoms present since age 6 with no waxing and waning.
• No other cause for the inattention/hyperactivity.

2.

It is important to ask about psychiatric comorbidities because theseoccur in the majority of patients with ADHD. Bipolar disorder has a particularaffinity with ADHD. The distinguishing features of bipolar disorder are:

• Onset at an early age, especially during the teenage years.
• Long-lasting depression, especially with resistance to antidepressantmedication.
• Family history of depression and other mood disorders.
• Frequent recurrence of depression.
• Obvious manic episodes and/or cycling moods.

Even when bipolar disorder and ADHD co-occur, the diagnosis ofADHD is seldom difficult; however, if a patient is in a manic phase, diagnosingADHD will require more clinical acumen-and possibly more time.

3.

Administer a mood disorder questionnaire

²

to anyone in whombipolar disorder is suspected.

- Paul P. Doghramji, MD
   Collegeville, Pa

References:

REFERENCES:

1.

World Health Organization. Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist. Available at:

http://www.med.nyu.edu/psych/assets/adhdscreen18.pdf

[PDF]. Accessed April 17, 2006.

2.

Hirshfeld RM, Williams JB, Spitzer RL, et al. Primary Care Mood Disorders Questionnaire. Available at

http://www.psycheducation.org/PCP/pcmdq6.doc

[DOC]. Accessed April 17, 2006.