Can bipolar hide ADHD symptoms during mood episodes?

PostedNovember 20, 2025

UpdatedNovember 21, 2025

ByMy Patient Advice

Author: Harriet Winslow, BSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Bipolar disorder and ADHD often share overlapping symptoms, which can make it challenging to tell them apart, especially during mood changes. According to NHS guidance, both conditions affect focus, motivation, and emotional control, but their timelines differ. ADHD is a lifelong neurodevelopmental condition, with symptoms starting before age 12, while bipolar disorder typically appears later and involves distinct episodes of mania and depression. When the two occur together, mood shifts can temporarily hide or imitate ADHD symptoms, making assessment more complex. Evidence from NICE NG87 and NG136 emphasises that understanding the pattern, duration, and onset of symptoms is essential for accurate diagnosis and treatment planning.

Understanding the overlap between bipolar disorder and ADHD

When bipolar disorder and ADHD coexist, the symptoms can intertwine in ways that make each condition harder to recognise. According to NHS Scotland’s ADHD guidance, overlapping traits such as distractibility, restlessness, and impulsivity can appear during both manic and depressive states. Clinicians therefore focus on whether these traits are episodic (bipolar) or persistent (ADHD).

Symptom overlap and masking during mood episodes

During manic or hypomanic periods, people may become overactive, talk rapidly, or take risks, which can look similar to ADHD hyperactivity. In contrast, during depression, they might struggle to focus or feel unmotivated, echoing ADHD inattention. A PubMed review (2025) found that mood fluctuations can make it difficult to spot true ADHD symptoms until mood stability is achieved. The main difference lies in the chronic nature of ADHD symptoms versus the cyclical pattern of bipolar disorder.

Diagnostic challenges and clinical strategies

Studies suggest that around 10–20% of people with bipolar disorder also have ADHD. The Royal College of Psychiatrists advises clinicians to take a detailed childhood history and involve family members to ensure accuracy. NICE guidance recommends deferring ADHD diagnosis until mood symptoms have stabilised to avoid confusion between conditions. A combined assessment by a psychiatrist or psychologist familiar with both disorders can improve diagnostic confidence and guide appropriate treatment.

Distinguishing features and assessment approach

For ADHD, clinicians look for consistent symptoms of inattention, impulsivity, and hyperactivity across multiple settings and over many years. For bipolar disorder, attention is given to cycles of mood elevation or depression that differ from a person’s normal state. Structured assessments, rating scales, and input from relatives are encouraged by NICE to clarify the diagnosis and support effective care.

Key takeaway

Bipolar disorder can sometimes hide or mimic ADHD symptoms, especially during mood swings. According to NICE and NHS guidance, ADHD should only be diagnosed when mood is stable and long-standing childhood symptoms are evident. A specialist review can help ensure that each condition is recognised and managed appropriately, supporting better outcomes for people affected by both.

Harriet Winslow, BSc

Author

Harriet Winslow is a clinical psychologist with a Bachelor’s in Clinical Psychology and extensive experience in behaviour therapy and developmental disorders. She has worked with children and adolescents with ADHD, autism spectrum disorder (ASD), learning disabilities, and behavioural challenges, providing individual and group therapy using evidence-based approaches such as CBT and DBT. Dr. Winslow has developed and implemented personalised treatment plans, conducted formal and informal assessments, and delivered crisis intervention for clients in need of urgent mental health care. Her expertise spans assessment, treatment planning, and behavioural intervention for both neurodevelopmental and mental health conditions.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.