ATTENTION-DEFICIT HYPERACTIVITY DISORDER AND JUVENILE MANIA - AN OVERLOOKED COMORBIDITY

Objective: To evaluate the psychiatric, cognitive, and functional corr elates of attention-deficit hyperactivity disorder (ADHD) children wit h and without comorbid bipolar disorder (BPD). Method: DSM-III-R struc tured diagnostic interviews and blind raters were used to examine psyc hiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academi c, social, school, and family functioning. Results: BPD was diagnosed in 11% of ADHD children at baseline and in an additional 12% at 4-year follow-up. These rates were significantly higher than those of contro ls at each assessment. ADHD children with comorbid BPD at either basel ine or follow-up assessment had significantly higher rates of addition al psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical pictu re of bipolarity was mostly irritable and mixed. ADHD children with co morbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD a nd BPD was not due to symptom overlap. ADHD children who developed BPD at the 4-year follow-up had higher initial rates of comorbidity, more symptoms of ADHD, worse scores on the CBCL, and a greater family hist ory of mood disorder compared with non-BPD, ADHD children. Conclusions : The results extend previous results documenting that children with A DHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.