A childhood history of attention deficit/hyperactivity disorder (ADHD) has a significant impact on the course of bipolar disorder, regardless of whether ADHD symptoms persist in to adulthood, researchers have found.

“Cross-sectional studies suggest that up to 85% of prepubertal children with bipolar disorder also meet the criteria for ADHD, and, conversely, that up to 22% of children with ADHD also meet the criteria for bipolar disorder,” explain Mikael Landen (Karolinska Institute, Stockholm, Sweden) and team.

However, less is known about the prevalence of comorbid ADHD in adults with bipolar disorder and whether such symptoms influence the clinical course of the mood disorder.

“The question whether childhood ADHD has the same impact on bipolar disorder regardless of whether the ADHD symptoms remain in adulthood or not is critical, because it opens up the possibility that a mere history of childhood ADHD symptoms defines an etiologically distinct, early-onset bipolar sub-phenotype,” they add. 

To investigate, the researchers studied 60 men and 99 women with bipolar disorder who were aged an average of 39 years.

The participants underwent comprehensive evaluations to assess affective symptoms, childhood ADHD, and current ADHD symptoms. An interview with a parent was also conducted to obtain objective information about a history of childhood ADHD.

Overall, 114 (71.7%) patients had “pure” bipolar disorder without childhood or adulthood ADHD symptoms, 19 (12.0%) had a history of childhood ADHD without symptoms in adulthood, and 26 (16.4%) met criteria for ADHD in both childhood and adulthood.

Analysis revealed that the presence of either childhood only ADHD or childhood plus adult ADHD had a similar impact on the clinical course of bipolar disorder.

Patients with childhood only ADHD and those with childhood plus adult ADHD had a significantly earlier age at onset of their first psychotic symptom, at a combined average age of 14.2 years, than those with pure bipolar disorder, at an average age of 21.9 years.

Furthermore, both ADHD groups had a significantly earlier combined average age (16.7 years) at first affective episode than those with pure bipolar disorder (22.7 years).

The researchers also found that patients with childhood only and childhood plus adult ADHD experienced significantly more hypomanic, depressive mixed, and total affective episodes, and they more often had a history of interpersonal violence than those with pure bipolar disorder.

Landen et al conclude in the journal Acta Psychiatrica Scandinavica: “We found that childhood ADHD is common in bipolar patients and that a mere history of childhood ADHD irrespective of current ADHD is an important factor for the clinical course of bipolar disorder.”

They add: “A review of childhood ADHD symptoms in adult bipolar patients is warranted both clinically and in pathophysiological studies.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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