ADHD Vs. Bipolar: How to Tell the Difference

What Is ADHD?

ADHD is referred to as attention-deficit hyperactivity disorder and is considered a neurological disorder. This is usually diagnosed in childhood, but the number of adult ADHD diagnoses is growing. Those who have ADHD often have a higher likelihood of having co-occurring conditions such as depression, anxiety, and bipolar disorder. 1 in 4 children ages 17 and younger will likely have ADHD as a diagnosis based on current trends. Of this group of children, about half are likely to also experience behavioral issues, and a third are likely to experience anxiety and/or depression. Symptoms of ADHD vary and can overlap with other conditions. Common symptoms include inattentiveness, hyperactive-impulsive behavior, or a combination of the two.

Common symptoms of inattentive ADHD include:

• Easily distracted
• Poor short-term memory
• Interrupting conversations
• Losing track of time
• Changing plans or activities

Common symptoms of hyperactive-impulsive ADHD include:

• Increased impulsivity
• Difficulty focusing
• Fidgeting
• Moving their bodies a lot
• Frequently talking

What Is Bipolar Disorder?

Bipolar disorder is a type of mood disorder that impacts energy, affect, and communication. Many with bipolar disorder struggle to communicate their emotions and needs. They may have aggressive and drastic mood swings that can also be reflected in their communication and language. It is important to note that there are different types of disorders: Bipolar Disorder, Bipolar I, and Bipolar II.

About 4% of the adult US population currently lives with bipolar disorder. They all experience bipolar cycles, which refers to the highs (manic episodes) and lows (depressive episodes) that occur in bipolar episodes. About half of those living with bipolar disorder develop a substance use disorder and depression. Risk factors of bipolar disorder include substance use, trauma history, and a family history of bipolar disorder or other mood disorders.

Common depressive symptoms of bipolar include:

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

Common manic symptoms of bipolar include:¹

• Overly inflated self-esteem
• Increase in risky behaviors such as gambling
• Restlessness
• Racing thoughts
• Easily distracted
• Reckless behavior
• Impulsive

Why is Bipolar Often Misdiagnosed as ADHD?

Bipolar disorder and ADHD do have quite a bit in common when looking at symptoms and the ways in which one expresses the condition. It is vital to know that they are different, and it is important to get an accurate diagnosis. The challenge of these two conditions is being able to decipher where each symptom is coming from to understand the root cause, which can make it difficult to receive an accurate diagnosis.

Someone who presents with a bipolar manic episode can look like ADHD as they experience impulsivity, a likelihood of not being able to stay focused on one task, and being easily distracted by their surroundings. They are also very sensitive to certain stimuli like sound, which can exacerbate these symptoms. Someone who presents with a bipolar depressive episode can look like ADHD with a low mood, fatigue, and the inability to begin a task. This can look like ADHD paralysis. It is important to note that sometimes getting an accurate diagnosis can take time, and working with your therapists and doctors can help you avoid a misdiagnosis. Specifically in the case of ADHD and bipolar disorder, these conditions commonly co-occur, thus complicating the process.

Overlapping symptoms in ADHD and bipolar include:²

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

ADHD Misdiagnosis in Bipolar Children

Bipolar in children is often misdiagnosed as ADHD, as many believe the behaviors associated with bipolar disorder are typically only seen in adults. It is believed that children, who are still developing and learning, very rarely can receive a bipolar diagnosis. However, that is not the case. Bipolar disorder can develop in children, and with assessments from a child psychiatrist, children can receive the correct diagnosis. It can sometimes be harder to diagnose a developing child with something like bipolar disorder, as many of the symptoms of challenges in childhood can appear severe. That is why it is critical to talk to professionals about what you are seeing in children, both emotionally and behaviorally, and any cycles or patterns you observe.³

ADHD Vs. Bipolar

There are common differences between bipolar disorder and ADHD. With ADHD, symptoms usually are seen very early on and continue to develop over time. Those with bipolar disorder often have a specific cycle of emotions they go through. In ADHD, baseline mood is generally stable, whereas that is not the case with bipolar disorder. ADHD is considered a neurodevelopmental disorder, while bipolar is considered a mood disorder. Both conditions are treatable.

Here are six questions that help differentiate between ADHD and bipolar:

1. What Is the Age of Onset?

The onset of ADHD is usually during the early teen years or pre-teen years. For bipolar disorder, the age of onset is usually around age 25. It is important to consider if there is a history of other conditions and how the individual has responded to stressful stimuli over time.

2. How Do the Symptoms Change Over Time?

ADHD symptoms tend to improve over time, and even those who are undiagnosed ADHD and receive a late ADHD diagnosis, tend to handle things better than they did in previous years. For bipolar disorder, symptoms often become worse with age, especially for those who are undiagnosed.

3. Are There Triggers for the Mood Swings?

Both people with bipolar and ADHD have intense mood swings, but an ADHD mood swing will be in response to something in their environment, whereas a bipolar mood swing is not. With ADHD, the reaction is a response to a change that is hard for the person with ADHD to adapt to. For bipolar disorder, the mood swing is much more random without a known cause.

4. Are the Symptoms Cyclical?

ADHD behaviors are stable or chronic, whereas bipolar behaviors are cyclical. For bipolar disorder, the cycles include periods of depression followed by periods of mania. For ADHD, there isn’t a pattern, but rather a reaction to their environment, and if there are changes in their environment, they will express themselves then.

5. What is Their Family History?

It is important to note that ADHD has some genetic factors, and bipolar disorder has a genetic basis, so looking at the family history can be helpful in understanding what disorder the person has. It is possible for someone to have both, even if a family member only had one.

6. How Do They Respond to Different Medications?

Although ADHD and bipolar symptoms are very similar, individuals with different disorders will respond very differently to different medications. When a person with ADHD is given stimulants, such as Adderall, they become calmer; however, a person with bipolar often becomes more manic with this medication and benefits more from mood stabilizers.

How to Get the Right Diagnosis

If you feel you have ADHD or bipolar disorder, the first step would be to talk to your therapist or talk to your physician. They will likely refer you to a couple of specialists who have experience in both diagnoses and have you go through some testing to determine the baseline etiology of your symptoms. The process involves multiple sessions with psychiatrists, talk therapy, and medication trials to see what medications you respond well to.

Bipolar Vs. ADHD Treatment

There are various methods of treatment used for bipolar and ADHD. Some of the treatment methods overlap and some are different. Therapy is important for both conditions, though the approach styles may differ. To find the right therapist, you may want to search an online therapist directory and talk to your network of family and friends for support.⁴

Treatment for ADHD

There are different treatment options available for ADHD. The timeline of treatment can vary depending on the individual. Your therapist may start you on medication earlier on to see your response, 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. For children, working with a child psychologist or someone specializing in neurodiverse therapy is important for both children and parents to learn how to work with their child’s ADHD. For the treatment for adults with ADHD, talk therapy and medication is the best approach.

Treatment options for ADHD include:

• Medication for ADHD: Medication for ADHD works to stimulate a focus and often is in the stimulant class of drugs. It works to increase dopamine in the brain.
• Cognitive behavioral therapy (CBT): CBT for ADHD can be helpful in learning how to manage thoughts with an ADHD diagnosis to know how to respond to stay on track.
• Dialectical behavioral therapy (DBT): DBT helps to keep us grounded through mindfulness-based approaches, which is very helpful for ADHD.
• Natural remedies: Exercise, spending time in nature, and music therapy are a few examples of natural remedies for ADHD and work by stimulating the dopamine response in the brain.

Treatment for Bipolar

There are also different treatment options for bipolar. The timeline for bipolar can look different and can be longer than that of ADHD due to the layered nature of bipolar disorder, and oftentimes, the co-occurrence of a trauma history, depression, PTSD, and anxiety. The best treatment approach is talk therapy and medication, and for children, working with a child psychologist is key. 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 actions that follow are productive and helpful.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT helps to improve the relationship you have with your tasks and schedule.
• Family therapy: Family therapy helps by bringing the whole support system together to learn how to be helpful for the individual with bipolar disorder, and also for the family to have support, as being a caregiver can be challenging.⁵

When to Seek Professional Support

If you find yourself struggling and have been for longer than usual, it is important to talk to a professional. It can be easy to wait and hold off on seeing someone, but it is important to go before it becomes worse and you are in a crisis. You can search an online therapist directory or online therapy platform, as both are good choices for finding a therapist who specializes in either bipolar or ADHD treatment. They may recommend you also speak with a psychiatrist to obtain medication, but working with a therapist is a good first stop. There are also online psychiatrist options for those who may need the flexibility with virtual visits.

In My Experience

In my experience, it can be difficult to tell the difference between ADHD and bipolar disorder at times, but it is possible as long as you stay the course and adhere to treatment. I would encourage all to seek support with both ADHD and bipolar disorder and know that you are not alone. The outlook is favorable for those who remain compliant with treatment and can live on to have a full life with rich relationships and joy.