10. The misbehavior of children who are ADHD is often accidental. If they crash into a wall (or a limit or an authority figure), it is often due to oblivious inattentiveness. The child who is bipolar, in the other hand, is more likely to crash into a wall with intent, for the sake of challenging its presence, Children who are bipolar are highly aware of "the wall" and are sensitive to ways of creating the biggest feeling of impact or challenge to it.

11. The child who is ADHD may stumble into a fight, whereas the child who is bipolar will look for a fight and enjoy the power struggle. While a child who is ADHD may engage in self-endangering behavior without noticing the danger, the child who is bipolar enjoys the danger and seeks it out. The child who is bipolar is intentionally dare-devilish (yet needle phobia is quite prevalent). In general, the danger-seeking is grandiosity ("I'm invincible") in the child who is bipolar and inattentiveness in the child who is ADHD.

12. In the child who is bipolar, danger-seeking grandiosity, energized giggling, and sexual hyperawareness may be seen early in the preschool years, and persist into adolescence and adulthood.

13. The natural course of ADHD is chronic and continuous, but tends toward improvement. There may be periods of worsening, however, during situational or developmental stress, or if a coexisting conduct disorder worsens. Children with bipolar disorder may or may not show clear behavioral episodes or cycles, but they do tend to exhibit increasingly more severe or dramatic symptoms over the course of years, particularly as the child becomes larger and the impulsivity becomes more difficult to contain.

14. Children with ADHD do not exhibit psychotic (thoughts and behavior reveal a loss of contact with reality) symptoms unless thy have coexisting psychotic depression, preschizophrenia, a drug-induced psychosis, a psychotic grief reaction. Children with bipolar disorder may, on the other hand, exhibit gross distortions in perceiving reality or in interpreting affective (emotional) events. They may even exhibit paranoid-like thinking or openly sadistic impulses.

15. Lithium treatment generally improves bipolar disorder but has no or little effect on ADHD.

The Coexistence of ADHD and Bipolar Disorder

Children may have ADHD, bipolar disorder, or unipolar disorder (depression), and some children have a combination of ADHD and bipolar disorder or ADHD and unipolar disorder (depression). A child who has either bipolar disorder or unipolar disorder, but not ADHD, may be misdiagnosed ADHD, however, because both the bipolar and unipolar disorders may include symptoms of inattention, impulsivity, and even hyperactivity. There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.

About the author: Dr. Charles Popper, MD is a psychopharmacologist from Harvard University

HealthyPlace.com information on childhood bipolar disorder.

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