Elevated mood and decreased sleep can discriminate juvenile-onset bipolar disorder (JO-BP) from attention-deficit hyperactivity disorder (ADHD) in children as young as 3 years of age, study results suggest.

“Considerable controversy surrounds the nature of the earliest symptom expression of childhood-onset bipolar illness and its prodromes,” explain Robert Post (Pennsylvania State University Medical School, Hershey, USA) and team.

They add that childhood-onset BP shows a high degree of comorbidity with ADHD and, although differential characteristics emerge later in the course of illness evolution, it is difficult to distinguish one disorder from the other in early childhood.

To gain a better insight into the symptom evolution of these disorders, the researchers examined the course of individual symptoms over the first 10 years of life in 27 children with bipolar disorder with or without ADHD, who were diagnosed before 9 years of age, and 22 children with ADHD alone.

The children were rated by a parent for the severity of 37 symptoms. These were drawn from literature describing common presentations of childhood psychopathology and were rated on a scale from 0 to 3, with 3 representing the most severe degree of impairment in the child’s usual family, social, or educational roles.

The team found the symptoms of hyperactivity, impulsivity, and decreased attention span were highly prevalent and showed a similar course in both groups.

“This might be expected because not only are these classic symptoms of ADHD, but are common in bipolar illness itself,” note the researchers.

However, extended periods of mood elevation and decreased sleep were significantly more common in the bipolar children than in those with ADHD, and were strong differentiators between the two disorders from as young as 3 years of age. Furthermore, the differences between bipolar children and those with ADHD regarding these symptoms increased in magnitude over the first 10 years of life.

Depressive and somatic symptoms were later differentiators that became significant from around 7 years of age.

Irritability and poor frustration tolerance differentiated the two groups only in their greater incidence and severity in bipolar children, compared with a more moderate incidence and course in those with ADHD.

Writing in the journal Bipolar Disorders, Post and team conclude: “These findings suggest the importance of examining juvenile- and adolescent-onset bipolar cohorts separately, especially when considering the earliest or prodromal manifestations of the full-blown illness.

“Those who receive a formal Schedule for Affective Disorders and Schizophrenia for School Age Children-confirmed bipolar diagnosis by an average age of 5 show the beginning of symptom separation from those with ADHD in the first few years of life, which then progressively increases in magnitude.”

Commenting on the implications of the findings, they add: “One can be hopeful that earlier recognition, diagnosis, and concerted treatment with one or more mood stabilizers or atypical antipsychotics in the context of appropriate psychosocial therapies, in lieu of treatment as usual, might yield a better outcome and, ultimately, a more benign course of illness.”

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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