An update on the debated association between ADHD and bipolar disorder across the lifespan

• Published in: Journal of affective disorders Vol. 141; no. 2; pp. 143 - 159
• Main Authors: Skirrow, Caroline, Hosang, Georgina M, Farmer, Anne E, Asherson, Philip
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 10-12-2012; Elsevier
• Subjects: Adult and adolescent clinical studies; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit disorders. Hyperactivity; Attention deficit hyperactivity disorder; Biological and medical sciences; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Bipolar disorders; Child clinical studies; Comorbidity; Diagnosis, Differential; Emotional dysregulation; Familial risk; Humans; Irritability; Irritable Mood; Life span; Longevity; Longitudinal Studies; Mania; Medical sciences; Mood disorders; Neurobiology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Mania; Emotional dysregulation; Bipolar disorder; Comorbidity; Familial risk; Attention deficit hyperactivity disorder; Mood disorder; Family study; Review; Emotional disorder; Concomitant disease; Risk factor; Development; Attention disorder with hyperactivity
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2012.04.003

Abstract Diagnostic formulations for attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD) both include symptoms of distractibility, psychomotor agitation and talkativeness, alongside associated emotional features (irritability and emotional lability). Treatment studies suggest the importance of accurate delineation of ADHD and BD. However, boundaries between the two disorders are blurred by the introduction of broader conceptualisations of BD. This review attempts to elucidate whether associations between ADHD and BD are likely to be driven by superficial symptomatological similarities or by a more meaningful etiological relationship between the disorders. This is achieved by outlining findings on comorbidity, temporal progression of the disorders, familial co-variation, and neurobiology in ADHD and BD across the lifespan. Longitudinal studies fail to consistently show developmental trajectories between ADHD and BD. Comparative research investigating neurobiology is in its infancy, and although some similarities are seen between ADHD and BD, studies also emphasise differences between the two disorders. However, comorbidity and family studies appear to show that the two disorders occur together and aggregate in families at higher than expected rates. Furthermore close inspection of results from population studies reveals heightened co-occurrence of ADHD and BD even in the context of high comorbidity commonly noted in psychopathology. These results point towards a meaningful association between ADHD and BD, going beyond symptomatic similarities. However, future research needs to account for heterogeneity of BD, making clear distinctions between classical episodic forms of BD, and broader conceptualisations of the disorder characterised by irritability and emotional lability, when evaluating the relationship with ADHD.