How To Tell the Difference Between ADHD vs Bipolar Disorder

ADHD and Bipolar disorder are two very different conditions, but they overlap in some ways. The connection between the way these conditions display sometimes leads to a misdiagnosis of one or the other, and it’s also possible for people to receive a diagnosis of both.

In this article, I’ll outline how to tell the difference between ADHD and Bipolar disorder, as well as the symptoms, diagnosis, and treatment for both. Lastly, we’ll go over the similarities between both conditions and what to do if you think that you may live with either disorder.

What Is ADHD?

ADHD is short for attention-deficit/hyperactivity disorder. It is a neurodevelopmental condition that is characterized by symptoms of inattention, hyperactivity/impulsivity, or both.

Someone who lives with ADHD may have primarily hyperactive/impulsive ADHD, primarily inattentive ADHD, or ADHD with a combined presentation, meaning that they experience clinically significant symptoms of both hyperactivity/impulsivity and inattention.

Although a person can get an ADHD diagnosis at any point in their life. ADHD symptoms must begin in childhood before the age of 12 and have to be clinically significant for a diagnosis to occur. Symptoms must also not be explained more effectively by another disorder, though living with a comorbid condition is both very possible and very common among people who live with ADHD. ADHD is different from ADD or just attention deficit disorder.

What Is Bipolar Disorder?

Bipolar disorder is a common mental health condition characterized by highs and lows that alternate. The “highs,” called mania or hypomania, include an abnormally elevated or irritable mood. On the other hand, the “lows” refer to a depressive episode.

Hypomania is a lower-level, or less severe, form of mania. There’s more than one type of Bipolar disorder. The types of Bipolar disorder include Bipolar 1, Bipolar 2, and cyclothymia or cyclothymic disorder.

The distinction between Bipolar 2 disorder and Bipolar 1 disorder is that a person who lives with Bipolar 1 disorder will have experienced a full-blown manic or a mixed episode at least once, whereas someone who lives with Bipolar 2 disorder will have experienced only hypomania along with at least one major depressive episode.

When it comes to cyclothymia or cyclothymic disorder, a person will experience alternating periods and symptoms of both depression and hypomania, but they won’t meet the full criteria for Bipolar disorder. 

ADHD vs Bipolar Disorder

Reading the two definitions above, you may wonder what these two conditions have in common. One example of how they can look similar on the outside is that ADHD can come with hyperactivity and impulsivity, and mania in those with Bipolar disorder can come with impulsivity and an increase in energy. The way that these disorders are treated differs. 

Symptoms

Understanding the symptoms of ADHD and Bipolar disorder can help you understand how the disorders intersect, as well as how they’re diagnosed. While Bipolar disorder never goes away, up to 9% of children with ADHD may grow up to find that symptoms are no longer clinically significant.

Both disorders have no known singular cause, though there are risk factors that can increase the likelihood that a person will live with either condition. 

ADHD

A person who lives with ADHD may have predominantly inattentive ADHD, predominantly hyperactive/impulsive ADHD, or ADHD with a combined presentation. If aged 17 or older at the time of diagnosis, they must have at least 5 symptoms of either inattention, hyperactivity/impulsivity, or both, for an ADHD diagnosis to occur. If someone is below the age of 17 at the time of diagnosis, they must experience 6 symptoms in one or both areas. 

Inattention symptoms include: 

• Forgetfulness. 
• Misplacing important items (e.g. pens, car keys, technology). 
• Appearing as though one isn’t listening when spoken to directly.
• Making seemingly careless mistakes.
• Difficulty sustaining one’s attention in tasks or play activities.
• Failure to finish tasks (e.g. schoolwork, chores, workplace duties) or follow through on instructions. 
• Avoidance, dislike, or reluctance to engage in tasks that require sustained mental effort or attention (e.g. homework). 
• Being easily distracted by external stimuli. 
• Trouble organizing tasks and activities.

Hyperactivity/impulsivity symptoms include:

• Interjecting into other people’s conversations or activities.
• Blurting out the answer to a question before it’s completed
• Appearing as though one’s “always on the go” or “driven by a motor”
• Leaving one’s seat when one’s expected to remain seated.
• Climbing or running in situations where it’s inappropriate to do so (in adolescents or adults, this may be limited to feeling restless). 
• Difficulty playing or engaging in leisure activities quietly. 
• Fidgeting, squirming, or tapping of the hands or feet.
• Difficulty with waiting for one’s turn.
• Talking excessively. 

Bipolar Disorder

Someone who lives with Bipolar disorder will alternate between periods of elevation or mania/hypomania and depression. At times, they may also experience stages where they are at a baseline and aren’t experiencing symptoms. The duration of an episode plays a role in diagnosis.

Depression symptoms include: 

• A depressed, down, or low mood.
• Loss of interest in activities an individual would typically enjoy.
• Tiredness, fatigue, low energy, or decreased efficiency in routine tasks.
• Differences in appetite (eating too much or too little).
• Differences in sleep (sleeping too much or too little).
• Social isolation or withdrawal from others.
• Changes in psychomotor activity (i.e. may move more slowly than usual).

Mania is characterized by an abnormally and persistently elevated, irritable, or expansive mood alongside three (or four, if the mood is irritable) or more of the following symptoms:

• A decreased need for sleep 
• Grandiosity or inflated self-esteem
• Excessive or pressured speech
• Risky or impulsive behavior (e.g. reckless driving, excessive spending)
• Racing thoughts or flight of ideas
• Increase in psychomotor activity or goal-directed activities
• Distractibility 

Diagnosis

A diagnosis of ADHD or Bipolar disorder is contingent on the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Health Disorders or DSM-5. Both conditions must be diagnosed by a licensed healthcare professional. 

ADHD

An ADHD diagnosis requires that:

• Symptoms aren’t better explained by another condition or cause.
• Symptoms began prior to the age of 12 (even if a diagnosis made after the age 12). 

The average age of diagnosis for someone with severe ADHD is age 4, whereas for moderate ADHD, it is age 6, and for mild ADHD, it is age 7. However, a parent often notices symptoms of ADHD prior to their child’s diagnosis. Although the complaints about possible symptoms may originate from parents, teachers or other caregivers.

Bipolar Disorder

A diagnosis of Bipolar disorder requires that:

• Symptoms aren’t better explained by another condition or cause.
• A person has experienced at least one episode of mania or hypomania. A manic episode must have lasted for a week or more, or hypomania must last for four days or more.

The average age of onset for Bipolar disorder is between 19-31 years of age, with a generally accepted decline after 50 years of age. However, the onset can be sooner. It’s estimated that Bipolar disorder affects between 0.5% - 1% of adults in the United States.

Treatment

ADHD and Bipolar disorder are both treatable, but not curable, conditions. This means that, while they are both chronic, it is possible for symptoms to improve. Someone who lives with ADHD, Bipolar disorder, or both, can have a full and successful life.

ADHD

Stimulants are often used as medication to treat ADHD as first line treatment options in those older than 6 years of age. For preschool children, they can be added if behavioral interventions fail. Examples of stimulants may include but are not limited to Adderall and Ritalin which contain four active ingredients – dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate.

Other treatment modalities can include but aren’t limited to combination therapy, behavioral interventions, school based interventions, social skills training, psychotherapy interventions.

Bipolar Disorder

Medication options such as mood stabilizers and antipsychotics are often utilized to treat Bipolar disorder in combination with therapy. Self-care (lifestyle regularity) is also often an important aspect of treatment and can include getting enough sleep, managing stress, and other practices that help a person as a unique individual. Like with ADHD, a proper diagnosis can help a person get the treatment they need. 

Peer support options may be helpful both for Bipolar disorder and ADHD in addition to treatment, as can workplace or educational accommodation. Other conditions, including oppositional defiant disorder and anxiety disorders, are both more likely to be seen in those who live with Bipolar disorder and more likely to be seen in those who live with ADHD.

Similarities 

At the end of the day, what are the parallels between Bipolar disorder vs. ADHD? Similarities in Bipolar disorder and ADHD can include:

• Changes in mood.
• Having more energy than is expected at times.
• Difficulty sleeping.
• Talking excessively/excessive speech.
• Trouble focusing or distractibility.
• Impulsive behavior and ADHD

Furthermore, family history is a risk factor for both. This means that if you have an immediate family member with Bipolar disorder, you may be more likely to live with Bipolar disorder yourself, and if you have an immediate family member, such as a blood-related parent or sibling, with ADHD, you are more likely to live with ADHD yourself.

If a person who lives with ADHD also experiences depression - common comorbidity - there is a possibility that they could be misdiagnosed with Bipolar disorder due to a combination of hyperactivity/impulsivity symptoms and depression symptoms.

One significant note when it comes to parsing out the difference between the two is that ADHD symptoms are persistent, whereas a person with Bipolar disorder experiences alternating episodes. So, if someone has ADHD, their symptoms will be relatively consistent; if someone experiences excessive speech, distractibility, or impulsivity, it’ll be clinically significant on a consistent basis and will not be strictly episodic.

If you believe that you may live with Bipolar disorder or ADHD, or if you believe that a child in your care might be experiencing one of these conditions, consult with a medical professional such as a pediatrician, primary care doctor, or psychiatrist who can help. 

This article is for informational purposes and is not a substitute for individual medical or mental health advice. Please consult with your or your child's prescribing doctor before changing, starting, or stopping a medication routine.