How consistent the behaviors are. ADHD symptoms tend to be chronic, while bipolar disorder is generally more episodic. ADHD tends to improve over time; bipolar disorder often gets worse, especially if proper treatment is delayed.

Treating these illnesses routinely starts with mood-stabilizing medications. Studies are looking into the effectiveness of other forms of therapy like psychotherapy. In ADHD, treatment may require stimulant or newer nonstimulant medications. When both disorders are present, the mood component is treated first. Studies are looking into the effectiveness of other forms of therapy like psychotherapy for these conditions.

"The most important thing is for parents to get their child a thorough diagnostic evaluation," Penberthy tells WebMD. "That means the doctor doesn't just talk to the person who brings the child in, but gets info from multiple sources, including teachers, Little League coaches, peers, and daycare providers."

With either disorder, the earlier you catch it, the better. Proper diagnosis and treatment not only reduces the impairment in functioning due to symptoms, but it hopefully prevents the long-term effects that may occur if the disorder is untreated.

"Research shows that having ADHD symptoms in childhood can have negative effects in adolescence and adulthood, such as substance abuse, low academic achievement, interpersonal conflicts, low self-esteem, and high physical injury rates," says Penberthy.

Untreated bipolar disorder can result in a phenomenon known as "kindling," where each episode has the effect of setting the stage for future episodes, which may worsen over time. In the case of bipolar disorder and ADHD together, there is an even greater need for careful and accurate diagnosis, since the stimulant medications that can successfully treat ADHD may actually worsen manic symptoms of bipolar disorder.

Parents also play a big role and need to be persistent in finding knowledgeable doctors and challenging them if they think their child is misdiagnosed. Even under ideal circumstances, finding the right combination of medications, especially with bipolar disorder, requires some trial and error.

Joyce (who asked that her last name not be used) went through years of misdiagnoses and incorrect treatments with her son, Shane, starting when he was 7 years old. Shane is bipolar and experienced several episodes involving mania, depression, and violence before getting his illness under control.

"He's almost 12 now, and it's taken us until this year to get the correct combination and dosage of medication," she says. "He'll never be 'normal' and will always need medication, but to anyone who doesn't know him, they now see a typical boy full of life, charm, and a kind heart."

Published Jan. 10, 2005.

SOURCES: J. Kim Penberthy, PhD, assistant professor, department of psychiatric medicine, University of Virginia. Stephanie Hamarman, MD, chief of psychiatry, Stanley Lamm Institute of Long Island College Hospital, Brooklyn, N.Y. Differentiating ADHD From Bipolar disorder in Children, George T. Lynn, MA, MPA, LMHC. National Institute of Mental health.

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