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Answer 5
  1. Pediatric bipolar disorder. ADHD with comorbid major depression or comorbid oppositional defiant disorder as well as recurrent major depression should be considered in the differential diagnosis. However, this patient’s history of mood symptoms, including elevated and depressed episodes, is strongly suggestive of pediatric bipolar disorder.8 The fact that the patient’s attention and concentration symptoms are related to mood episodes is inconsistent with ADHD, as impairments of attention in ADHD are chronic and relatively consistent over time. A recent study found that children with pediatric bipolar disorder had greater problems with difficult temperament in both infancy and toddlerhood compared with children with ADHD.9

    8. Leibenluft E, Rich BA. Pediatric bipolar disorder. Annu Rev Clin Psychol 2008;4:163–87.

    9. West AE, Schenkel LS, Pavuluri MN. Early childhood temperament in pediatric bipolar disorder and attention deficit hyperactivity disorder. J Clin Psychol 2008;64:402–21.

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