Attention-deficit/hyperactivity disorder and pediatric-onset bipolar disorder

Is the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and manic symptoms a true comorbidity or an artifact of methodology? Clinically, symptoms of mania have been discounted as "bad" ADHD or ignored in the context of aggressive conduct disorder. This atypicality may lead to neglect of the mood component. The addition of bipolar symptoms contributes to the severe morbidity, dysfunction, and incapacitation observed in a subset of children with ADHD. A comprehensive approach to diagnostic evaluation is the keystone to establishing an effective treatment program, as response to treatment differs with individual disorders. What was previously considered refractory ADHD, oppositionality, aggression, and conduct disorder may respond after mood stabilization.