title: Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?
abstract: OBJECTIVE
  To evaluate the psychiatric, cognitive, and functional correlates of attention-deficit hyperactivity disorder (ADHD) children with and without comorbid bipolar disorder (BPD).
  
  
  METHODS
  DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academic, 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 controls at each assessment. ADHD children with comorbid BPD at either baseline or follow-up assessment had significantly higher rates of additional psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical picture of bipolarity was mostly irritable and mixed. ADHD children with comorbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD and 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 history of mood disorder compared with non-BPD, ADHD children.
  
  
  CONCLUSIONS
  The results extend previous results documenting that children with ADHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.
authors: Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
authors: J
authors: J
authors: Biederman
authors: S
authors: S
authors: Faraone
authors: E
authors: E
authors: Mick
authors: J
authors: J
authors: Wozniak
authors: L
authors: L
authors: Chen
authors: C
authors: C
authors: Ouellette
authors: A
authors: A
authors: Marrs
authors: P
authors: P
authors: Moore
authors: J
authors: J
authors: Garcia
authors: D
authors: D
authors: Mennin
authors: E
authors: E
authors: Lelon
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000175:diagnosis*; D001714:Bipolar Disorder / Q000150:complications* / Q000175:diagnosis; D002648:Child; D015897:Comorbidity; D006801:Humans; D011569:Psychiatric Status Rating Scales; D000297:Psychology, Adolescent