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The Boundaries Between Normality, ADHD and PBD in Child Psychiatric Clinical Practice
Current Issue
Volume 2, 2015
Issue 3 (June)
Pages: 101-108   |   Vol. 2, No. 3, June 2015   |   Follow on         
Paper in PDF Downloads: 58   Since Aug. 28, 2015 Views: 2042   Since Aug. 28, 2015
Helen Lazaratou, Child and Adolescent Psychiatric Unit, Community Mental Health Centre, 1st Psychiatric Department, Medical School, University of Athens, Athens, Greece.
Aikaterini Kapoulea, Child and Adolescent Psychiatric Unit, Community Mental Health Centre, 1st Psychiatric Department, Medical School, University of Athens, Athens, Greece.
Dimitris C. Anagnostopoulos, Child and Adolescent Psychiatric Unit, Community Mental Health Centre, 1st Psychiatric Department, Medical School, University of Athens, Athens, Greece.
Attention-Deficit Hyperactivity Disorder (ADHD) is considered one of the most common neurobehavioral disorders of childhood. Clinical descriptions and diagnostic criteria for ADHD have been redefined over time; current conceptualization of the syndrome is characterized by lack of attention and/or hyperactivity-impulsivity. Epidemiological studies show large differences in the incidence, indicating that the effort of current taxonomic systems to offer diagnostic accuracy have not yielded substantial results. Bipolar Disorder (BD) with onset in childhood, commonly referred as Pediatric Bipolar Disorder (PBD), is distinguished from the adult type by the rarity of affective symptoms. Neither depressive mood nor hypomanic euphoria is apparent in the clinical picture of bipolar children and adolescents. Instead they exhibit a severe irritability and their symptoms are expressed in consecutive cycles, which include brief episodes of depressive, hypomanic, manic or mixed periods without free intervals. There has been a delay in the recognition of this clinical picture. Nevertheless, the diagnostic criteria in the current taxonomic systems are not separated from those of adults. The contemporary literature contemplates the relationship between ADHD and PBD. These two disorders share similar clinical picture with slight variations, thus the differential diagnosis in favour of PBD mainly based on the presence of affective disorders in the family. In this paper, we try to examine whether comorbidity exists, whether ADHD is over-diagnosed against PBD or whether ADHD represents a prodromal manifestation of PBD. Children with ADHD-PBD comorbidity tend to express mostly an irritable phenotype with a chronic course and have higher rates of conduct disorders. This suggests a symptomatic continuum spectrum between ADHD and PBD which is possibly responsible for the difficulties met in differential diagnosis and the variation of comorbidity rates. It seems that the earlier the onset of PBD more often it is associated with symptoms of ADHD. The relationship between PBD and ADHD has important implications for treatment. The diagnostic confusion regarding the evaluation and relationship of these two clinical entities is strongly reflected in the proposed course of pharmaceutical treatment. The diagnostic issues concerning the diagnosis of ADHD versus PBD and their entangled relationship refer to the difficulty of defining the limits of normal and abnormal in the mental health of children and adolescents and the limitation of the taxonomic systems in respect to the particularities of this developmental age spectrum.
Attention-Deficit Hyperactivity Disorder (ADHD), Pediatric Bipolar Disorder (PBD), Comorbidity, Diagnostic Issues, Limitations, Normality
Lazaratou, H., Zilikis, N. (2006) The French classification of child and adolescent mental disorders (CFTMEA): A comparison to ICD-10& DSM-IV. Psichiatrike, 17, 49-61.
Pataki, C., Carlson,G.A.,(2013) The Comorbidity of ADHD and Bipolar Disorder: Any Less Confusion? Curr. Psychiatry Rep, 15, 372-379.
Barkley, R.A., (1991) The ecological validity of laboratory and analogue assessments of ADHD symptoms. Journal of Abnormal Child Psychology, 19, 149-178.
Denckla,M.B., (1996) Biological correlates of learning and attention: What is relevant to learning disability and attention-deficit hyperactivity disorder?.Developmental and BehavioralPediatrics, 17, 114-119.
Shaywitz, B.A., Fletcher, J. M., Shaywitz, S. E., (1995) Defining and classifying learning disabilities and Attention-Deficit/Hyperactivity Disorder. Journal of Child Neurology, 10, S50-S57.
Halperin, J.M., Matier, K., Bedi, G., Sharma, V., Newcorn, J.H., (1992) Specificity of inattention, impulsivity, and hyperactivity to the diagnosis of attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 131, 190-196.
American Psychiatric Association (1968) Diagnostic and Statistic Manual of Mental Disorders (DSM-II) (2nd edition). Washington, DC.
Klein, D.F., Gittelman-Klein, R. (1975) Problems in the diagnosis of minimal brain dysfunction and the hyperkinetic syndrome. International Journal of Mental Health, 4, 45-60.
American Psychiatric Association (1980) Diagnostic and Statistic Manual of Mental Disorders (DSM-III) (3rd edition). Washington, DC.
Bauermeister, J. J., Alegria, M., Bird, H. R., Rubio-Stipec, M., Canio, G., (1992) Are attentional-hyperactivity deficits unidimensional or multidimensional syndromes? Empirical findings from a community survey. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 423-431.
Lahey, B. B., Carlson, C. L.,(1991) Validity of the diagnostic category of attention deficit disorder without hyperactivity: a review of the literature. Journal of Learning Disability, 24, 110-120.
Pelham, W. E., Gnagy, E. M., Greenslade, K. E., Milich, R., (1992) Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 210-218.
American Psychiatric Association (1994) Diagnostic and Statistic Manual of Mental Disorders (DSM-IV) (4th edition). Washington, DC.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM5) (5th ed.). Washington, DC.
Barkley, R.A., Grodzinsky, G., Du Paul, G. J., (1992) Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report. Journal of Abnormal Child Psychology, 20, 163-188.
Goodyear, P., Hynd, G. W., (1992) Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity. Journal of Abnormal Child Psychology, 1992, 6, 221-236.
Scahill, L.,Schwab-Stone, M., (2000) Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am., 9, 541-555.
Pressman, L.J., Loo, S.K., Carpenter, E.M., Asarnow, J.R., Lynn, D., Mccracken, J.T., Mcgough, J.J.M., Lubke, G.H., Yang, M.H., Smalley, S.L., (2006) Relationship of Family Environment and Parental Psychiatric Diagnosis to Impairment in ADHD. J Am Acad Child Adolesc Psychiatry, 45, 346-354.
Esquirol, J.E. (1838)Des maladies mentales considérées sous les rapports médical, hygiénique et medico- légal. Baillere, Paris.
Kraepelin, E. (1899) EinLehrbuch fur studiende und artzte. Barth, Leipzig.
Kochman, F., Ferrari, P., Hantouche, E.G., Akiskal, H.S., (2002) Les troubles bipolaires chez l’adolescent. In Ferrari, P., Ed., Actualités en Psychiatrie de l’Enfant et l’Adolescent, Flammarion, Paris, 282-290.
Wozniak, J., (2005) Recognizing and managing bipolar disorder in children. J Clin Psychiatry.66, 18-23.
Carbray, M. J., McGuinness, T., (2009) Pediatric bipolar disorder. J Psychosoc Nurs Ment Health Serv., 47, 22-6.
Craney, J. L., Geller, B., (2003) A prepubertal and early adolescent bipolar disorder – I phenotype: review of phenomenology and longitudinal course. Bipolar Disord. 5, 243-56.
Biederman, J., Faraone, S.V., Wozniak, J., Mick, E.,Kwon, A., Cayton, G.A.,Clark, S.V., (2005) Clinical correlates of bipolar disorder in a large, referred sample of children and adolescents. J Psychiatr Res., 39, 611-622.
Tillman, R., Geller, B., Bolhofner, K., Craney, J.L.,Williams, M., Zimerman, B., (2003) Ages of onset and rates of syndromal and sub-syndromal comrbid DSM-IV diagnoses in a prepubertal and early adolescent bipolar disorder phenotype. J Am Child Adolesc Psychiatry, 42, 1486-1493.
Wozniak, J.,Biederman, J., (1997) Childhood mania: insights into diagnostic and treatment issues. J AssocAcad Minor Phys, 8, 78-84.
Issac, G., (1995)Is bipolar disorder the most common diagnostic entity in hospitalized adolescents and children?.Adolescence, 30, 273-276.
Meyer, T.D., Kossmann – Bohm, S., Schlottke, P.F., (2004) Do child psychiatrists in Germany diagnose bipolar disorders in children and adolescents? Results from a survey. Bipolar Disord, 6, 426-431.
Kochman, F.J., Hantouche, E.G., Ferrari, P., Lancrenon, S., Bayart, D., Akiskal, H.S., (2005) Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord., 85, 181-189.
Soutullo, C.A., Chang, K.D., Díez-Suárez, A., Figueroa-Quintana, A., Escamilla-Canales, I., Rapado-Castro, M., Ortuño, F., (2005) Bipolar disorder in children and adolescents: international perspective on epidemiology and phenomenology. Bipolar Disord, 7, 497-506.
Stringaris, A., Santosh, P., Leibenluft, E., Goodman, R., (2010) Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry. J Child Psychol Psychiatry, 51, 31-38.
Taylor, E., (2009) Managing bipolar disorders in children and adolescents. Nat Rev Neurol., 5, 484-491.
Cicero, D.C., Epler, A. J., Sher, K. J. (2009). Are there developmentally limited forms of bipolar disorder? J Abnorm Psychol., 118, 431-447.
Shankman, S.A., Lewinsohn, P.M., Klein, D. N., et al., (2009) Subthreshold conditions as precursors for full syndromes disorders: a 15- year longitudinal study of multiple diagnostic classes. J Child Psychol Psychiatry, 50, 1485-1494.
Tijssen, M. J., Van Os, J., Wittchen, H. U., et al., (2010) Prediction of transition from common bipolar experiences to bipolar disorder:10-year study. Br J Psychiatry, 196, 102-108.
Schapiro, N.A., (2005) Bipolar disorders in children and adolescents. Journal of Pediatric Health Care, 19, 131-141.
Wozniak, J., Faraone,S.V., Mick, E., Monuteaux, M., Coville, A., Biederman, J. (2010) A controlled family study of children with DSM-IV bipolar-I disorder and psychiatric co-morbidity.Psychol Med., 40, 1079-1088.
Birmaher, B., Axelson, D., Goldstein, B., Monk, K., Kalas, C., Obreja, M., Hickey, M.B., Iyengar, S., Brent, D., Shamseddeen, W., Diler, R., Kupfer, D., (2010) Psychiatric disorders in preschool offspring of parents with bipolar disorder: the Pittsburgh Bipolar Offspring Study (BIOS).Am J Psychiatry., 167, 321-330.
Kochman, F., Rose-Reinhardt, H., Hantouche, E., (2005) Les jeunes hyperactifs deviennent-ils bipolaires? Inter Psy, 4, 30-34.
Biederman, J., Mick, E., Prince, J. et al., (1999) Systematic chart review of the pharmacologic treatment of comorbid attention deficit hyperactivity disorder in youth with bipolar disorder. J Am Acad Child Adolesc Psychiatry, 9, 247- 256.
Geller, B., Zimerman, B., Williams, M., Bolhofner, K., Craney, J.L., Delbello, M. P., Soutullo, C.A., (2000) Diagnostic characteristics of 93 cases of a prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention deficit hyperactivity disorder. J Child Adolesc Psychopharmacol, 10, 157-164.
Faraone,S.V., Biederman, J., Wozniak, J., Mundy, E., Mennin, D., O’Donell, D., (1997) Is comorbidity with ADHD a marker for juvenile-onset mania? J Am Acad Child Adolesc Psychiatry, 36, 1046- 1055.
Verhulst, F.C., Van der Ende, J., Ferdinand, R.F., Kasius, M.C., (1997) The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents. Arch Gen Psychiatry, 7, 51-55.
Srinath,S., Reddy,Y.C.J., Girimaji, S.C., et al., (1998) A prospective study of bipolar disorder in children and adolescents from India. ActaPsychiatrScand, 98, 437-442.
Biederman, J., Faraone, S., Mick, E., Wozniak, J., et al., (1996) Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity? J Am Acad Child Adolecs Psychiatry, 35, 997-1008.
Wozniak, J., Biederman, J., Kiely, K., Ablon, J. S., Faraone, S. V., Mundy, E., Mennini, D., (1995) Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. J Am Acad Child Psychiatry, 34, 867-876.
Masi, G., Perugi, G., Toni, C., Millepiedi, S., Mucci, M., Bertini, N., Pfanner, C., (2006) Attention-deficit hyperactivity disorder – bipolar comorbidity in children and adolescents. Bipolar Disord, 8, 373-381.
McIntyre, R., (2009) Bipolar disorder and ADHD: Clinical concerns. CNS Spectr., 14, 8-9.
Rucklidge, J. J., (2006) Impact of ADHD on the Neurocognitive Functioning of Adolescents with Bipolar Disorder. Biological Psychiatry, 60, 921-928.
Adler, C. M., Delbello, M. P., Mills,N.P., Schmithorst, V., Holland, S., Strakowski, S. M., (2005) Comorbid ADHD is associated with altered patterns of neuronal activation in adolescents with bipolar disorder performing a simple attention task. Bipolar Disord, 7, 577-588.
Jaideep, T., Reddy, Y. C., Srinath, S., (2006) Comorbidity of attention deficit hyperactivity disorder in juvenile bipolar disorder. Bipolar Disord, 8, 182-187.
Tillman, R., Geller, B., Craney, J.L., Bolhofner, K., Williams, M., Zimerman, B., Frazier, J., Beringer, L., (2003) Temperament and character factors in a prepubertal and early adolescent bipolar disorder phenotype compared to attention deficit hyperactive and normal controls. J Child Adolesc Psychopharmacol., 13, 531-543.
Chang,K.D., (2010) Course and impact of bipolar disorder in young patients. The Journal of clinical psychiatry, 71, e05-e05.
Fakra, E., Kaladjian, A., Da Fonseca, D., Maurel, M., Adida, M., Besnier, N., Pringuey, D., Azorin, J.M., (2010) Prodromal phase in bipolar disorder. L'Encephale, 36, S8-12.
Halmøy, A., Halleland, H., Dramsdahl, M., Bergsholm, P., Fasmer, O. B., Haavik, J., (2010) Bipolar symptoms inadult attention-deficit/hyperactivity disorder: across-sectional study of 510 clinically diagnosed patients and 417 population-based controls. J Clin Psychiatry. 71, 48-57.
Wingo, A. P., Ghaemi, S. N., (2007) A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder. The Journal of Clinical Psychiatry, 68, 1776-1784.
McIntyre, R. S., Kennedy, S. H., Soczynska, J. K., Nguyen, H. T., Bilkey, T. S., Woldeyohannes, H. O., Nathanson, J. A., Joshi, S., Cheng, J. S., Benson, K. M., Muzina, D. J., (2010)Attention-deficit/hyperactivity disorder in adults with bipolar disorder or major depressive disorder: results from the international mood disorders collaborative project. The Primary Care Companion to the journal of Clinical Psychiatry, 12: e1–e7.
Nierenberg, A.A., Miyahara, S., Spencer, T., Wisniewski, S.R., Otto, M.W., Simon, N., Pollack, M. H., Ostacher, M. J., Yan, L., Siegel, R., Sachs, G.S., (2005) STEP-BD Investigators.: Clinical and diagnostic implication of lifetime attention- deficit/hyperactivity disorder comorbidity in adults with bipolar disorder: data from the first 1000 STEP-BD participants. Biol Psychiatry, 57, 1467-1473.
Bernardi, S., Cortese, S., Solanto, M., Hollander, E., Pallanti, S. (2010) Bipolar disorder and comorbid attention deficit hyperactivity disorder. A distinct clinical phenotype? Clinical characteristics and temperamental traits. World J Biol Psychiatry, 11, 656-666.
Moreno, C., Laje, G., Blanco, C., Jiang, H., Schmidt, A. B., Olfson, M., (2007) National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry 64, 1032-1039.
Lewinsohn, P.M., Klein, D. N., Seeley, J.R., (2000) Bipolar disorder during adolescent and young adulthood in a community sample. Bipolar Disorders, 2, 281-293.
Consoli, A., Deniau, E., Huynh, C., Purper, D., & Cohen, D. (2007) Treatments in child and adolescent bipolar disorders. European child & adolescent psychiatry, 16, 187-198.
DelBello, M. P., Soutullo, C.A., Hendricks, W., Niemeier, R. T., McElroy, S. L., & Strakowski, S. M. (2001) Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset. Bipolar Disorders, 3, 53-57.
Soutullo, C.A., DelBello, M. P., Ochsner, J. E., McElroy, S. L., et al., (2002) Severity of bipolarity in hospitalized manic adolescents with history of stimulant or antidepressant treatment. Journal of affective disorders, 70, 323-327.
Willens, T. E., Pelham, W., Stein, M., Conners, C. K., Abikoff, H., Atkins, M., (2003) ADHD treatment with once-daily OROS methyphenidate: interim12-months results from a long term open label study. J Am Child Adolesc Psychiatry, 42, 424-433.
Faeda, G. L., Baldessarini, R.J., Glowinsky, I. P., Austin, N.B., (2004) Treatment –emergent mania in pediatric bipolar disorder: a retrospective case review. J Affect Disord, 82, 149-158.
Zeni, C. P., Tramontina, S., Ketzer, C.R., Pheula, G. F., Rohde, L.A., (2009) Methylphenidate combined with aripiprazole in children and adolescents with bipolar disorder and attention-deficit/hyperactivity disorder: a randomized crossover trial. J Child Adolesc Psychopharmacol., 19, 553-561.
Galanter, C.A., Carlson, G. A., Jensen, P.S., et al., (2003) Response to methylphenidate in children with attention deficit hyperactivity disorder and manic symptoms in the multimodal treatment study of children with attention deficit hyperactivity disorder trial. J Child Adolesc Psychopharmacol, 13, 123-136.
Ross, R.G., (2006) Psychotic and manic like symptoms during stimulant treatment of Attention Deficit Hyperactivity Disorder. Am. J. Psych, 163, 1149-1152.
Scheffer, R. E., Kowatch, R.A., Carmody, T., Rush, A. J., (2005) Randomized , placebo- controlled trial or mixed amphetamine for symptoms of comorbid ADHD in pediatric bipolar disorder after mood stabilization with divalproex sodium. Am J Psychiatry, 162, 58-64.
Chang, K., Nayar, D., Howe, M., Rana, M., (2009) Atomoxetine as an adjunct therapy in the treatment of co-morbid attention-deficit/hyperactivity disorder in children and adolescents with bipolar I or II disorder. J Child Adolesc Psychopharmacol., 19, 547-551.
Hegerl, U., Himmerich, H., Engmann, B., Hensch, T., (2010) Mania and attention-deficit/hyperactivity disorder: common symptomatology, common pathophysiology and common treatment? Curr Opin Psychiatry, 23, 1-7.
Hegerl, U., Sander, C., Olbrich, S., Schoenknecht, P., (2009) Are psychostimulants a treatment option in mania? Pharmacopsychiatry, 42, 169-174.
Tramontina, S., Zeni, C. P., Ketzer, C.R., et al., (2009) Aripiprazole in children and adolescents comorbid with attention deficit hyperactivity disorder. A pilot randomized clinical trial. J Clin Psych, 70, 756-764.
Biederman, J., Hammerness, P., Doyle, R., et al., (2008) Risperidone treatment of ADHD in children and adolescents with bipolar disorder. Neuropsyciatr Dis Treat, 4, 203-207.
Zilikis, N., (2003) Classification issues in Child and Adolescent Psychiatry. In, out and on Psychiatry, 4, 61-65.
Anagnostopoulos, D.C., Lazaratou, H., (2003) The issue of comorbidity in Child Psychiatry. Archives of Hellenic Medicine, 20, 463-465.
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