Hyperactivity in attention-deficit/hyperactivity disorder (ADHD) refers to excessive motor activity, impulsivity, and restlessness.
ADHD hyperactivity and manic symptoms like psychomotor agitation, racing thoughts, and impulsivity conceptually converge. Thus measures of hyperactivity in ADHD may tap similar underlying phenomena as mania rating scales intended to index separate conditions.
Key Points
Rationale
Attention-deficit/hyperactivity disorder (ADHD)and bipolar disorder ormanic episodescan manifest with overlapping symptoms, including distractibility, impulsivity, hyperactivity, and racing thoughts. However, clear differentiation is imperative for optimal treatment (Barden et al., 2023).
While ADHD persists across situations and time, mania symptoms fluctuate episodically with significant impairment (Brus et al., 2014). Further, mania includesgrandiositynot typical in ADHD (Skirrow et al., 2012).
Though self-reportquestionnairesoffer assessment efficiency, research indicates substantial item content similarities and limitations distinguishing these conditions (Newson et al., 2020). Still, few studies have directly analyzed the relationship between specific ADHD and bipolar measures.
Investigating these associations in adults seeking help for ADHD can strengthen diagnostic clarity and measurement-guided care (Barden et al., 2023).
Method
The study was aquantitative analysisof archival assessment data from adults seeking ADHD assessment at two U.S. outpatient clinics.
Participants completed the following scales:
Sample
119 adults seeking ADHD assessment (mean age 22 years); 52% female; 75% white; 91% had 12+ years education. Around 22% eventually diagnosed with ADHD; 5% bipolar disorder.
Statistical Analysis
Bivariate Pearson correlations, stepwise linear regressions (cross-validated with hierarchical regressions).
Results
As hypothesized, the bipolar and ADHD self-report measures were strongly intercorrelated (rs .43 to .74), suggesting they tap similar constructs.
The MCMI-IV Bipolar Spectrum Scale was most strongly associated with CAARS-S:L Impulsivity (r = .55) and Hyperactivity scales (r = .58). The BASC-3 Mania Scale was very highly correlated with ADHD Hyperactivity measures (rs .70 to .75) and total ADHD symptoms (r = .74), suggesting substantial overlap with behavioral symptoms.
When controlling for shared variance, bipolar/mania symptoms explained unique variance in ADHD symptoms, supporting study hypotheses. Specifically, the BASC-3 Mania Scale accounted for over half the variance in CAARS-S:L total ADHD symptoms (54%).
Additionally, the CAARS-S:L Hyperactivity Scale was consistently uniquely related to BASC-3 Mania scores in regression analyses. In line with the hypotheses, hyperactivity, and impulsivity symptoms accounted for 39% of the variance in bipolar spectrum symptoms on the MCMI-IV.
Insight
This study provides compelling evidence that self-report measures frequently used to assess ADHD and bipolar disorders—even a specific mania scale—share substantial conceptual overlap and are intertwined psychometrically.
Most critically, the BASC-3 Mania Scale exhibited extremely high correlations (rs ≥ .70) with ADHD symptom measures, calling into question whether commonly used mania scales effectively distinguish between manic and ADHD symptoms.
Further, bipolar/mania symptoms accounted for more than half the variance in total ADHD symptoms on the CAARS-S:L, and behavioral ADHD symptoms (hyperactivity, impulsivity) accounted for nearly 40% of variance in bipolar spectrum symptoms on the MCMI-IV.
These robust predictive relations likely reflect the behavioral and cognitive similarity of ADHD and mania/bipolar symptoms like high energy, racing thoughts, and impulsivity.
In assessment contexts, individuals with clinically elevated ADHD or bipolar symptoms on self-report inventories will likely have concurrent elevations across both types of measures.
Relying solely on self-report questionnaires could, therefore, result in inaccurate diagnostic uncertainty between the disorders or comorbidities. Using multiple assessment modes will be essential for differential diagnosis.
Future research should continue elucidating transdiagnostic processes linking ADHD and bipolar symptoms to optimize measurement and intervention.
Clinically, when elevated bipolar symptoms present alongside ADHD concerns or vice versa, further evaluation ruling out the alternative diagnosis will strengthen diagnostic clarity and allow patients to receive appropriately tailored treatments.
Strengths
This study has several notable strengths:
Limitations
However, some limitations temper the conclusions that can be drawn:
Implications
This study carries noteworthy implications for psychological and psychiatric assessment and diagnosis:
References
Primary reference
Barden, E. P., Polizzi, C. P., Vizgaitis, A. L., Bottini, S., Ergas, D., & Krantweiss, A. R. (2023). Hyperactivity or mania: Examining the overlap of scales measuring attention-deficit/hyperactivity disorder and bipolar spectrum disorders in an assessment context.Practice Innovations, 8(2), 102–115.https://doi.org/10.1037/pri0000202
Other references
Brus, M. J., Solanto, M. V., & Goldberg, J. F. (2014). Adult ADHD vs. bipolar disorder in the DSM-5 era: A challenging differentiation for clinicians.Journal of Psychiatric Practice, 20(6), 428–437.https://doi.org/10.1097/01.pra.0000456591.20622.9e
Newson, J. J., Hunter, D., & Thiagarajan, T. C. (2020). The heterogeneity of mental health assessment.Frontiers in Psychiatry, 11, Article 76.https://doi.org/10.3389/fpsyt.2020.00076
Skirrow, C., Hosang, G. M., Farmer, A. E., & Asherson, P. (2012). An update on the debated association between ADHD and bipolar disorder across the lifespan.Journal of Affective Disorders, 141(2-3), 143–159.https://doi.org/10.1016/j.jad.2012.04.003
Keep Learning
Here are some thought-provoking discussion questions about this research a college class could explore:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
