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Bipolar Disorder More Likely in ADHD: Presented at APA

By Paula Moyer

SAN DIEGO, CA -- May 24, 2007 -- Children with attention deficit hyperactivity disorder (ADHD) are significantly more likely to go on to develop bipolar disorder (BP) in adulthood compared with children without ADHD, according to investigators who presented their findings here at the American Psychiatric Association 2007 Annual Meeting (APA).

"In this longitudinal study, approximately 6.5% of subjects with ADHD went on to develop bipolar disorder compared to 1% of controls," according to principal investigator James G. Waxmonsky, MD, assistant professor of psychiatry, University of Buffalo, Buffalo, New York, United States. "The prevalence of bipolar disorder was greater than that seen in other longitudinal ADHD studies, but far less than the 15% to 20% reported in child psychiatry clinics."

The investigators followed 364 children with ADHD for 8 years after they had participated in a summer camp for ADHD subjects in an effort to determine the prevalence of bipolar disorder and potential moderators. They also recruited and followed 225 demographically similar non-ADHD controls. The investigators interviewed the subjects and their parents annually during the study period.

In order for the subjects to be considered to have bipolar disorder, the subjects were required to have a diagnosis in their treatment records as well as documentation of treatment with antimanic medications in at least 2 waves. Subjects who were required to take antimanic medication for ADHD and had an internalizing disorder and anger outbursts, but were not diagnosed as bipolar, were labelled as having bipolar disorder not otherwise specified (NOS). The investigators confirmed a diagnosis of major depressive disorder (MDD) if the subjects required antidepressant usage for depression for at least 1 year. They also assessed the subjects' psychiatric diagnosis with the Structured Clinical Interview for Diagnostic and Statistical Manual-IV (DSM-IV) (SCID) at the time that they achieved 18 years of age.

Among these subjects, 24 (6.5%) of those with ADHD developed bipolar disorder, compared with 2 (1%) of those in the control group. On the self-reported SCID, 5 ADHD subjects and 2 controls meet the criteria for BP. No SCID-identified cases had been formally diagnosed with BP and therefore were not counted as positive cases. Interestingly, none of the cases who were being treated for bipolar disorder were identified as bipolar on the SCID.

The subjects with ADHD were more likely to develop MDD, with an odds ratio (OR) of 3.1 (P <.001). They had an OR of 8.4 for developing bipolar disorder (P <.001). Among those ADHD subjects with bipolar disorder, a family history of mood disorders was more likely than among those ADHD subjects without a mood disorder (P <.05).

The investigators documented no association between socioeconomic status, lifetime usage of stimulants, or a maternal history of depression and the development of either MDD or bipolar disorder. The incidence of family conflict was higher in subjects with ADHD and mood disorders than in ADHD subjects without mood disorders (P <.05). Those elevated childhood scores on the 4 mood symptoms from the Conner's Abbreviated Parent Questionnaire were significantly more likely to develop bipolar disorder and MDD (P <.01 for each).

[Presentation title: Prevalence and Predictive Factors of Bipolar Disorder (BP) in Young Adults With Pediatric Attention Deficit Hyperactivity Disorder (ADHD). Abstract NR640]

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