It is important to recognize that children with ADHD may also experience irritability or dysphoria due to demoralization and decreased self-esteem, making the differential diagnosis with bipolar disorder difficult. In these cases one would expect to see an increase in the intensity or severity of symptoms. Like bipolar disorder, conduct disorder frequently emerges during adolescence. These children usually engage in high-risk behaviors with the potential for painful consequences seen in mania. However, unlike the manic child, the conduct disorder child's motives are more hurtful, vindictive, antisocial.
Psychotic symptoms are also significant in determining diagnosis.
These are not present in disruptive disorders, but may be present during an acute bipolar episode or with thought disorders. Manic symptoms are recognized as a barometer of psychopathology severity in children and adolescents and have been correlated with greater psychosocial impairment. Respondents to the DMDA survey acknowledged the negative impact on their lives, reporting problems with crime, substance abuse, self-injurious behavior or aggression toward others, unstable relationships, gambling and financial difficulties and interruption in their education. Thorough evaluation and treatment are essential. A biopsychosocial approach to intervention that incorporates psychoeducation and school intervention is warranted.