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Clinical research: Autism, bipolar disorder may often overlap

by  /  20 September 2013

Double hit: Symptoms of bipolar disorder, such as aggressive outbursts, may mask subtle symptoms of autism in children who have both disorders.

As much as 30 percent of children diagnosed with bipolar disorder may also have autism, suggests a study published in the June issue of the Journal of Clinical Psychiatry1.

Bipolar disorder affects about 1 percent of children and is characterized by severe mood swings between mania and depression. Some of the symptoms, such as irritability and aggression, are also common in autism.

Clearly distinguishing bipolar disorder from autism is important, as treatment for one disorder may not be beneficial for the other. Symptoms of one disorder may also mask diagnosis of the other.

For example, one 8-year-old boy in the study was hospitalized six times after age 5 for aggressive outbursts that involved harm to himself and others. After 10 years old, when these outbursts calmed as a result of successful therapeutic treatment, his caretakers also noted that he had rigid thinking, had deficits in social skills and isolated himself from his peers. At 11, he was diagnosed with pervasive developmental disorder-not otherwise specified.

To address possible comorbidity between bipolar disorder and autism, the researchers looked at 155 children with bipolar disorder, from 6 to 17 years of age, and 487 of their first-degree relatives. Trained psychologists diagnosed autism in 47, or about 30 percent, of these children.  

The children with both diagnoses have symptoms of bipolar disorder that are similar to those of children who have bipolar disorder alone, the study found. The children who have both disorders were diagnosed with bipolar disorder at a younger age, however. These children also have elevated symptoms of grandiosity — inflated self-esteem or belief that they have special powers.

The researchers also looked at family history of bipolar disorder in this group, and in another group of 162 children with attention deficit hyperactivity disorder (ADHD) and 511 of their first-degree relatives. They also looked at 136 children with no symptoms of ADHD, autism or bipolar disorder, and 411 of their first-degree relatives.

Family members of children with bipolar disorder are significantly more likely to have a family history of psychosis than those of children with ADHD or controls. Family members of children who have both autism and bipolar disorder have the same risk of psychosis as do family members of children with just bipolar disorder.

This suggests that the children diagnosed with both disorders have true bipolar disorder and not just symptoms of autism misdiagnosed as bipolar disorder, the researchers say.

References:

1: Joshi G. et al. J. Clin. Psychiatry 74, 578-586 (2013) PubMed


  • RA Jensen

    Sir Michael Rutter prefers the term co-occurring, I agree. The term ‘comorbidity’, implies unsubstantiated presumption of independent etiologies. Rutter argues that discrete categories do not exist in real life. Many common specific genetic variants associated with ASD risk are also associated with risk for SLI, Dyslexia, ADHD, depression, social anxiety, eating disorders, immune deficiencies gastrointestinal problems, bi-polar disorder, developmental language delay, intellectual disability etc., many or most of which can co-occur in any individual with general developmental problems associated with the same common polymorphisms. The MET (7q31) gene region harbors a polymorphism, the MET promoter variant rs1858830 allele “C” that is present in 47% of the general population and is associated with autism, immune function, gastrointestinal repair, neuronal growth and development.

    Reference

    Randolph-Gips M. Srinivasan P. (2012). Modeling Autism: A systems biology approach. J Clin Bioinforma. 2012; 2: 17.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507704/

    • Paul Patterson

      Autism and bipolar also share the maternal infection risk factor. Alan Brown and colleagues recently showed that the risk for bipolar in the offspring is increased nearly 4-fold if the mother had influenza during pregnancy. This is consistent with the Danish study of over 10,000 autism cases showing increased risk when the mother had an infection during first trimester.

      References
      Parboosing et al. (2013) Gestational influenza and bipolar disorder in adult offspring. JAMA Psychiatry, doi:10.1001/jamapsychiatry.2013.896.

      Atladottir et al. (2010) Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. J Autism Dev Disord 40:1423-30.

  • Hany Sayed Ahmed

    Amazing study
    but how we can difference between ASD and bipolar?
    If a child with autism already have history of aggression,SIB,anger behavior, laughing crisis,screaming or tantrum.
    How we can diagnose this cases by bipolar?
    with my best wishes

    • Planet Autism

      Funny you should ask that because I was going to post to point out, with all these conditions being clinically diagnosed, there exists the risk of misdiagnosis. I am sure many of the supposed bipolar traits could be explained by autism and/or ADHD. Try asking an autistic what it is like to exist in a neurotypically favoured society, you will soon find the cause of moodiness and depression. I do have to therefore ask, whether it is in fact possible for autism and bipolar to co-exist and whether the supposed bipolar cases identified as having autistic traits, were never bipolar at all, and were autistics misdiagnosed.

  • Planet Autism

    With all these conditions being clinically diagnosed, there exists the risk of misdiagnosis. I am sure many of the supposed bipolar traits could be explained by autism and/or ADHD. Try asking an autistic what it is
    like to exist in a neurotypically favoured society, you will soon find the cause of moodiness and depression. I do have to therefore ask, whether it is in fact possible for autism and bipolar to co-exist and whether the supposed bipolar cases identified as having autistic traits, were never bipolar at all, and were autistics misdiagnosed.

    • thisisthelist

      “This suggests that the children diagnosed with both disorders have true bipolar disorder and not just symptoms of autism misdiagnosed as bipolar disorder, the researchers say.”

      I recommend taking what the experts are saying to heart. It is possible to have both conditions, or a condition on the spectrum that represents an overlap between the two.

      • Planet Autism

        “I recommend taking what the experts are saying to heart”

        Having encountered many professionals selling themselves as experts, who have been anything but, the term expert appears to be far too loosely used in many cases.

        My comment was not meant to be mutually exclusive, simply to consider other options and one of those, is misdiagnosis.

        • thisisthelist

          I think I get where you’re coming from, but my response to “I do have to therefore ask, whether it is in fact possible for autism and bipolar to co-exist.”, based on my own journey caring for a family member, is it appears to be extremely, extraordinarily likely that some human beings can have, and should have, both diagnoses.

          • Planet Autism

            I guess until we have some form of medical test to be definitive, we will never know 100% for sure. When someone has a diagnosis of ASD that can potentially mean any co-morbid condition presents atypically and this can confound.

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