How to differentiate between hyperactive-impulsive ADHD and bipolar disorder?

PostedSeptember 15, 2025

UpdatedSeptember 17, 2025

ByMy Patient Advice

Author: Lucia Alvarez, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Differentiating between ADHD in children, particularly the hyperactive-impulsive type , and bipolar disorder can be challenging, as both conditions share traits like mood instability, impulsivity, and difficulty with emotional regulation. However, there are key differences in how these symptoms are present, especially in terms of timing, intensity, and context.

In ADHD symptoms, impulsivity and restlessness are consistent and present across most situations, school, home, or play. Children may struggle daily with sitting still, interrupting others, or acting without thinking. In contrast, bipolar disorder typically involves distinct mood episodes: periods of elevated energy (mania or hypomania) alternating with depression, often lasting days or weeks. These mood swings are more episodic and may not be tied to specific triggers or environments.

How to tell the difference

Here are some distinguishing features to help guide parents and professionals:

Symptom duration and patterns
ADHD-related behaviours are chronic and observable from early childhood. Bipolar symptoms usually emerge later and come in cycles or episodes.

Emotional shifts
Children with bipolar disorder may exhibit intense mood changes without warning, while those with ADHD in children typically display more reactive, short-lived frustrations.

Impact on academic performance
Both conditions can disrupt academic performance, but in ADHD, difficulties stem from attention and executive function challenges. In bipolar disorder, academic issues often worsen during mood episodes.

Response to treatment
Stimulant side effects may include sleep disruption or mood changes in children with ADHD, but in children with bipolar tendencies, stimulants can trigger mania or aggression, making careful diagnosis crucial.

Getting the right diagnosis early can transform outcomes. Visit providers like ADHD Certify for expert assessments and guidance tailored to your child’s unique needs.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Hyperactive‑Impulsive ADHD .

Lucia Alvarez, MSc

Author

Lucia Alvarez is a clinical psychologist with a Master’s in Clinical Psychology and extensive experience providing evidence-based therapy and psychological assessment to children, adolescents, and adults. Skilled in CBT, DBT, and other therapeutic interventions, she has worked in hospital, community, and residential care settings. Her expertise includes grief counseling, anxiety management, and resilience-building, with a strong focus on creating safe, supportive environments to improve 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 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.