Pediatric bipolar disorder and ADHD: Family history comparison in the LAMS clinical sample
J Affect Disord. 2012 Mar 30;
Authors: Arnold LE, Mount K, Frazier T, Demeter C, Youngstrom EA, Fristad MA, Birmaher B, Horwitz S, Findling RL, Kowatch R, Axelson D
Abstract
BACKGROUND:
Transgenerational association of bipolar spectrum disorder (BPSD) and attention deficit/hyperactivity disorder (ADHD) has been reported, but inconclusively.
METHOD:
Children ages 6-12 were systematically recruited at first outpatient visit at 9 clinics at four universities and reliably diagnosed;621 had elevated symptoms of mania (>12 on the Parent General Behavior Inventory 10-Item Mania Scale); 86 had scores below 12. We analyzed baseline data to test a familial association hypothesis: compared to children with neither BPSD nor ADHD, those with either BPSD or ADHD would have parents with higher rates of both bipolar and ADHD symptoms, and parents of comorbid children would have even higher rates of both.
RESULTS:
Of 707 children, 421 had ADHD without BPSD, 45 BPSD without ADHD, 117 comorbid ADHD+BPSD, and 124 neither. The rate of parental manic symptoms was similar for the comorbid and BPSD-alone groups, significantly greater than for ADHD alone and ‘neither’ groups, which had similar rates. ADHD symptoms in parents of children with BPSD alone were significantly less frequent than in parents of children with ADHD (alone or comorbid), and no greater than for children with neither diagnosis. Family history of manic symptoms, but not ADHD symptoms, was associated with parent-rated child manic-symptom severity over and above child diagnosis.
LIMITATIONS:
The sample was not epidemiologic, parent symptoms were based on family history questions, and alpha was 0.05 despite multiple tests.
CONCLUSIONS: These results do not support familial linkage of BPSD and ADHD; they are compatible with heritability of each disorder separately with coincidental overlap.
PMID: 22464937
A serious problem in neuroscience / psychiatric studies is that the mind has never been defined or determined. Thus the full pathophysiologic underpinnings of any mental illness is not known – since without a definition of the mind, the researchers do not know what to examine and measure. [In contrast, in my practice, I have developed a highly useful definition of the mind and can much better determine the pathophysiology underpinning mental illnesses.] When researchers do not know the pathophysiology of an illness, they have to treat a person as a black box and use statistics on the external manifestations of the illness. Statistical analysis never gives you causality. And such analysis is invalidated if one has an outlier. Further, it results in treatments at are more often than not, guesswork with results not much better than placebo.
A problem in studying ADHD is that often practitioners (physicians and therapists) do not recognize that ADHD plus anger/mood problems is ADHD plus a mood disorder. The child is often given a diagnosis of ADHD and Oppositional Defiant Disorder or Conduct Disorder – diagnoses that I strongly dislike since they define the child as a “bad child” and are not helpful other than giving the child a label for which the schools can use to suspend the child rather than give the child the educational intervention he or she needs. When I examine such children, they have the same pathophysiologies as those with bipolar disorder, depression, anxiety – the mood disorders. An additional factor is that should the child have a sufficient predisposition for mood problems – e.g. hypothalamic-pituitary-adrenal axis disregulation, nutritional deficiencies, etc. – then the treatment for ADHD with stimulants (or an increase in psychosocial stress) can collapse that child’s capacity to control mood, triggering the development of a mood disorder.
From my perspective and experience, there is a huge overlap in the pathophysiologies underpinning ADHD and the mood disorders like Bipolar Disorder. The pathophysiologies often involve multiple problems with the nervous system, endocrine system, immune system (which includes gastrointestinal health), metabolism and nutrition. The difference between the two illnesses is often one of severity in the underlying pathophysiologies – where bipolar disorder has more severe though same problems. There are heritable factors such as the tendency for neuroendocrine problems such as hypothyroidism and psychoimmunologic problems. There are socio-environmental problems that can look like they are inherited since both parent and child are subject to the same environment. These include nutritional deficiencies and psychosocial stresses such as poverty. Once the pathophysiology is identified a more effective treatment can be developed for each individual by targeting each pathophysiology.