title: Does comorbid bipolar disorder increase neuropsychological impairment in children and adolescents with ADHD?
abstract: OBJECTIVE
  To assess differences in executive functioning between children and adolescents with attention-deficit/hyperactivity disorder (ADHD) comorbid or not with bipolar disorder (BD), and to study the neuropsychological profile of subjects with the comorbidity in a clinical sample from a developing country.
  
  
  METHODS
  Case-control study comparing 23 participants with BD + ADHD and 85 ADHD-only subjects aged 6 to 17 years old. Both groups were drug-free. Executive function domains were assessed with the Stroop Test, the Wisconsin Card Sorting Test, and the Continuous Performance Test II.
  
  
  RESULTS
  The group with juvenile BD + ADHD showed a significantly worse performance on the Stroop task, including time in color (p = 0.002), time in color-word (p < 0.001), interference, number or errors in color and color-word (p = 0.001), and number of errors in word cards (p = 0.028). No between-group differences were found in other tests.
  
  
  CONCLUSIONS
  Our findings suggest that ADHD-only and ADHD + BD do not show differences in inhibitory control and set-shifting domains. However, children and adolescents with BD and comorbid ADHD show greater impairment in processing speed and interference control. This suggests a potentially higher impairment in the dorsolateral prefrontal cortex and may be a potential neuropsychological signature of juvenile BD comorbid with ADHD.
authors.affiliation: Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto AlegreRS, Brazil, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
authors.forename: Joana C
authors.initials: JC
authors.lastname: Narvaez
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Cristian P
authors.initials: CP
authors.lastname: Zeni
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Roberta P
authors.initials: RP
authors.lastname: Coelho
authors.affiliation: Graduate Program in Psychology, UFRGS, Porto AlegreRS, Brazil, Graduate Program in Psychology, UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Flavia
authors.initials: F
authors.lastname: Wagner
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Gabriel F
authors.initials: GF
authors.lastname: Pheula
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Carla R
authors.initials: CR
authors.lastname: Ketzer
authors.affiliation: Graduate Program in Psychology, UFRGS, Porto AlegreRS, Brazil, Graduate Program in Psychology, UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Clarissa M
authors.initials: CM
authors.lastname: Trentini
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Silzá
authors.initials: S
authors.lastname: Tramontina
authors.affiliation: Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, UFRGS, Porto AlegreRS, Brazil, Juvenile Bipolar Disorder Outpatient Program (ProCAB), Division of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Rohde
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000503:physiopathology*; D001714:Bipolar Disorder / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D003072:Cognition Disorders / Q000503:physiopathology*; D015897:Comorbidity; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D012016:Reference Values; D013997:Time Factors