BOSTON -- The use of an objective measure such as the Continuous Performance Test can help distinguish bipolar affective disorder from attention-deficit hyperactivity disorder in aggressive adolescents, Dr. Mark J. Smith reported in a poster presentation at the American Psychiatric Association's Institute on Psychiatric Services.
The diagnosis of bipolar disorder in children and adolescents is often made difficult by the absence of clearly defined cycles of elevated, depressed, or euthymic mood. Mania can be easily mistaken for attention-deficit hyperactivity disorder (ADHD), since both conditions are characterized by hyperactivity, impulsivity, distractibility, disorganization, and conduct problems, said Dr. Smith of Riverside Hospital and George Washington University, Washington, and the National Institute of Neurological Disorders and Stroke, Bethesda, Md.
Although other symptoms such as grandiosity, flight of ideas, hypersexuality, and rapid mood swings are unique to mania, all are subjective and none are actually required for the diagnoses. Structured clinical interviews can't distinguish bipolar mania from ADHD and the two typically end up being diagnosed as comorbid. However, correct diagnosis of bipolar mania in adolescents is important for making correct treatment choices, particularly with respect to assessing the need for mood stabilizers in addition to stimulants in those with comorbid ADHD, he noted.
Three groups of adolescents hospitalized for aggressive behavior--21 who met the MINI-kid diagnostic criteria for bipolar mania or hypomania, 38 who met ADHD criteria but not mania or hypomania, and 49 with neither disorder--were compared on the following: age, sex, MINI-kid diagnosis, prior medication, Continuous Performance Test (CPT) scores, and the presence of cognitive disorders based on the Woodcock-Johnson III. …