ADHD Vs. Bipolar: How to Tell the Difference

What Is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is a neurological condition that falls within the umbrella of neurodiversity. Symptoms of ADHD vary from person to person but typically include difficulties with impulse control and sustaining attention.

Depending on the type of ADHD, a person may appear more hyperactive, impulsive, or inattentive. Some exhibit a mix of symptoms, osculating between periods of increased activity and trouble focusing.

Common symptoms of inattentive ADHD include:

• Distractability
• Poor short-term memory
• Losing track of time
• Forgetfulness

Common symptoms of hyperactive-impulsive ADHD include:

• Increased impulsivity
• Restlessness
• Fidgeting
• Frequently talking

What Is Bipolar Disorder?

Bipolar disorder is a mood disorder that impacts energy, affect, and communication. Bipolar symptoms occur in cycles of high highs (manic episodes) or low lows (depressive episodes), contributing to drastic mood swings that impact overall functioning. 

Everyone experiences bipolar differently. For example, those with bipolar I typically exhibit extreme mania, sometimes followed by depressive episodes. On the other hand, individuals with bipolar II experience longer-lasting depressive episodes and less intense hypomania. 

depressive symptoms of bipolar include:¹

• Significant fluctuations in weight
• Change in sleeping patterns
• Fatigue
• Changes in appetite
• Feelings of worthlessness
• Low motivation

Common manic symptoms of bipolar include:¹

• Inflated self-esteem
• Increased risky behaviors
• Restlessness
• Racing thoughts
• Reckless behavior

ADHD Vs. Bipolar: What Is the Difference?

The primary differences between ADHD and bipolar are symptom intensity, duration, and stability. With ADHD, symptoms usually emerge in childhood and evolve with time. Additionally, the baseline mood with ADHD is generally stable, whereas emotions can shift suddenly and drastically for those with bipolar. These factors, along with others, can help individuals overlook the ADHD and bipolar overlap to recognize their distinct features.

Below are five differences between ADHD and bipolar disorder:

1. Age of Onset

A key difference between bipolar and ADHD is the age of onset. Parents and caregivers can often recognize signs of ADHD in their children as early as toddlerhood. Other times, symptoms become more apparent in childhood and adolescence. Conversely, the average age of onset for bipolar is 25.

2. Symptom Stability

ADHD and bipolar symptoms differ in their evolution. For example, symptoms of ADHD can improve over time, especially with adequate support and treatment. In other cases, undiagnosed individuals can learn to manage their symptoms as an accepted part of their lives, allowing them to adapt to their environments (even without knowing they have ADHD). 

For bipolar disorder, symptoms often become worse with age if untreated. However, treatment can significantly improve how those with the condition navigate life by providing positive coping and emotional regulation skills.

3. Triggers for Mood Swings

Both people with bipolar and ADHD have intense mood swings. However, an ADHD mood swing will be in response to an environmental factor, whereas a bipolar episode may not have a definitive cause.

4. Symptom Cycles

ADHD behaviors do not occur in cycles, meaning they are stable and chronic. Episodes of intense symptoms are not predictable, and various factors can contribute to heightened emotions, such as overstimulation or rejection. Conversely, bipolar behaviors are cyclical, and mania often follows episodes of depression.

5. Response to Medication

Although ADHD and bipolar symptoms are similar in some respects, a person with ADHD will respond differently to medications than someone with bipolar. For instance, those with ADHD report calming effects when taking stimulants like Adderall.* However, a person with bipolar may become manic on these prescriptions and benefit more from mood stabilizers.\

* This medication has a black box warning, the most serious kind of warning from the FDA for a risk of medication misuse or abuse.

Can I Have Both ADHD & Bipolar Disorder?

ADHD and bipolar disorder commonly co-occur. In fact, those with ADHD have a higher likelihood of experiencing co-occurring conditions, including bipolar disorder. While the exact reason for this increased risk is unknown, genetics and environmental factors likely play a role.

Can ADHD Be Misdiagnosed as Bipolar?

Because of the bipolar and ADHD overlap, receiving a misdiagnosis is possible. A bipolar manic episode can resemble ADHD in that someone experiences increased impulsivity. They may also exhibit distractibility, as their minds constantly race between thoughts. Mania can also increase sensitivity to external stimuli, further mirroring common sensory processing issues common in those with ADHD.

Because of these similarities, receiving an accurate diagnosis can take time. Individuals should ensure they are honest about their symptoms with their therapists and doctors to help avoid ADHD misdiagnosis.

Overlapping symptoms in ADHD and bipolar include:²

• Insomnia
• Mood swings
• Impulsivity
• Distractibility 
• Trouble focusing
• Low motivation to complete tasks
• Excessively talking

ADHD Misdiagnosis in Bipolar Children

Many overlook bipolar in children based on the idea that the condition typically affects adults. However, bipolar disorder can develop in childhood, and assessments from a child psychiatrist can provide a correct diagnosis. Again, symptoms of ADHD and bipolar can overlap, so adults should pay mindful attention to the emotional cycles a child exhibits. This information can help professionals determine the root cause of symptoms.³

ADHD Vs. Bipolar: Getting an Accurate Diagnosis

Seeking an accurate diagnosis is crucial when finding the best treatment and support. The first step would be consulting a therapist, doctor, or psychiatrist. They will likely refer you to specialists with experience in both diagnoses. They will administer tests to determine the baseline etiology of your symptoms, often through multiple psychiatric sessions, talk therapy, and various assessments. From there, your care team can develop a tailored treatment plan to help you cope with either diagnosis.

Bipolar Vs. ADHD: Treatment Options

The best treatment for bipolar and ADHD depends on the individual and their unique needs. Therapy is important for both conditions, though the approach styles may differ. Medication is also beneficial in reducing impactful symptoms, especially for those with bipolar who experience intense manic episodes.⁴

Treatment for ADHD

Different treatment options are available for ADHD. A therapist may start stimulants or non-stimulants to monitor responses, as many ADHD medications have an immediate impact. 

The best course of treatment is medication with talk therapy, and the goals of therapy can differ for everyone. Finding a neurodiverse-affirming therapist is important for children and adults to learn positive symptom management while fostering their strengths and honoring their support needs.

Treatment options for ADHD include:

• Medication for ADHD: Medication for ADHD increases specific neurotransmitters in the brain to improve focus and reduce impulsivity or hyperactivity. 
• Cognitive behavioral therapy (CBT): CBT for ADHD can help clients learn the connection between their thoughts, emotions, and behaviors to enact positive changes.
• Dialectical behavior therapy (DBT): DBT incorporates mindfulness-based approaches to ground clients in the present. This approach can help improve focus and attention for those with ADHD.
• Natural remedies: Exercise, time in nature, and music therapy for ADHD are a few examples of natural remedies for ADHD that work by stimulating the dopamine response in the brain.

Treatment for Bipolar

Treatments for bipolar disorder resemble those of ADHD because they include both talk therapy and medication. The timeline for bipolar may be longer due to the layered nature of the condition. 

With bipolar, a co-occurrence of depression, PTSD, and anxiety is also likely, meaning treatment may target additional challenges. Children may also benefit from a peer support group to learn social skills.

Treatment options for bipolar include:

• Medication for bipolar: Medication for bipolar can include mood stabilizers, SSRIs**, and SNRIs**, which all work to regulate and balance the brain chemicals.
• Cognitive behavioral therapy (CBT): CBT for bipolar helps to reframe thoughts so people can engage in healthy and helpful actions.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT explores how disruptions in your daily routine impact your symptoms. This information can help you identify and manage triggers.
• Family therapy: Family therapy brings the whole support system together to learn how to support the individual with bipolar disorder. The family members also receive support, as being a caregiver presents unique challenges.⁵

* This medication has a black box warning, the most serious kind of warning from the FDA for a risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting this medication.

When to Seek Professional Support

Talking with a professional can help you regain balance and peace in life. Waiting until you feel overwhelmed before seeking support is easy, especially when you have endless responsibilities and obligations. However, finding help before a crisis can help prevent worsening symptoms or long-lasting impacts.

You can search an online therapist directory or online therapy platform, as both are good choices for finding a therapist specializing in bipolar, ADHD, or combined treatment. They may also recommend you to a psychiatrist for medication management. Online psychiatrist options are available for those who need the flexibility of virtual visits.