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“[I]n addition to an ADHD diagnosis, a clinician should consider a whole range of possible psychiatric conditions.”1

-Dr. Laura Reale, MD, PhD, et al

“[I]n addition to an ADHD diagnosis, a clinician should consider a whole range of possible psychiatric conditions.”1

-Dr. Laura Reale, MD, PhD, et al

Mood disturbances can complicate a diagnosis of ADHD

Although attention-deficit/hyperactivity disorder (ADHD) and mood disturbances are distinct, pediatric patients may express common features. The table below can be used as a guideline for the differential distinctions between ADHD and mood disturbances.

Psychiatric Differentials
Behavior Disorders and ADHD

Mood Disturbances and ADHD2

Shared Features
Differential Distinguishers
Key Facts
Major depressive disorder (MDD)
Shared Features
  • Distractibility
  • Poor concentration
  • Low frustration tolerance
Differential Distinguishers
  • ADHD: disturbance in mood is characterized by irritability rather than sadness or loss of interest
  • MDD: poor concentration in mood disorders becomes prominent only during a depressive episode
Key Facts
  • Additional symptoms distinguishing primary depression from ADHD include sleep dysfunction, anhedonia, and feelings of low self-worth
Bipolar disorder
Shared Features
  • Labile mood
  • Difficulty modulating emotions
  • Attempting risky/dangerous feats
Differential Distinguishers
  • ADHD: children with ADHD may show changes in mood within the same day
  • Bipolar disorder: mood changes must last ≥4 days to be a clinical indicator
Key Facts
  • A diagnosis of bipolar disorder is suggested by extreme mood shifts, prolonged periods of depression or euphoria, or episodic thought disturbances
  • Bipolar disorder is relatively rare in children and adolescents; anger and irritability associated with ADHD are far more common
Anxiety disorders
Shared Features
  • Restlessness
  • Difficulty focusing
Differential Distinguishers
  • ADHD: restlessness is not typically associated with worry or ruminations
  • Anxiety disorder: patients may show excessive worry/panic in the face of everyday stressors and somatic issues (stomachaches, muscle tension)
Key Facts
  • Anxiety disorders are typically persistent, lasting 6 months or more

This table is intended as a quick reference guide only. For full diagnostic criteria, please refer to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–V).

Managing comorbid mood disturbances and ADHD

In patients with ADHD, the presence of psychiatric disorders should be considered in the treatment strategy.1

  • MDD, bipolar disorder, and anxiety disorder are among the most common comorbid conditions seen with ADHD3
  • While a combination of therapies may be necessary to treat comorbid conditions in patients with ADHD, it is recommended that mood disturbances be treated first3
  • Learn more about practice parameters and clinical guidelines for psychotropic medication management in children and adolescents here

Does the overlap of ADHD and mood disturbances suggest a common neurobiologic etiology? Take a deeper dive into the conversation on managing ADHD with psychiatric comorbidities.

More to ADHD

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References:1. Reale L, Bartoli B, Cartabia M, et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry. 2017;26(12):1443-1457. 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013. 3. Austerman J. ADHD and behavioral disorders: assessment, management, and an update from DSM-5. Cleveland Clinic J Med. 2015;82(suppl 1):S2-S7.