Differential diagnosis of pediatric mania*

	Mania or hypomania^¶	ADHD	Oppositional defiant disorder	Disruptive mood dysregulation disorder
Episodic	X
Euphoria	X
Decreased need for sleep^Δ	X
Grandiosity	X
Flight of ideas	X
Hypersexuality	X
Psychosis	X
Increase in goal-directed activity	X^◊	X^§
Talkativeness or pressured speech	X^◊	X
Silliness	X^◊	X
Increased energy	X^◊	X
Hyperactivity	X^◊	X
Impulsivity or high potential negative consequences	X^◊	X
Distractibility or poor concentration	X	X
Irritability/moodiness	X	X	X	X
Temper outbursts	X	X	X	X
Behavior problems	X^¥	X^¥	X	X
Depressive symptoms	X	X^‡	X	X

The symptoms are presented without taking into consideration that they can be comorbid among themselves and with other disorders, especially ADHD.

ADHD: attention deficit hyperactivity disorder.
* Disorders included in the table may be comorbid among themselves.
¶ A manic/hypomanic episode requires multiple concurrent symptoms for a minimum duration.
Δ Children with ADHD may show initial insomnia because they are hyperactive and sometimes stimulants can induce insomnia, especially at the beginning of treatment.
◊ The quality of these symptoms in mania/hypomania may differ from that of other disorders. As an example, youth with ADHD are energetic and hyperactive, whereas during an episode of mania/hypomania, energy can be very high and channeled into many activities like rearranging the room, cleaning the house, or high-risk behaviors.
§ Although goal activity appears to be increased in ADHD, often it is activity in general that has increased.
¥ Not a core symptom, but often observed as a consequence of the core symptoms (eg, impulsivity and lack of judgment) or a comorbid disorder.
‡ Not a core symptom, but observed as a consequence of the core symptoms (eg, demoralization) or comorbid depressive disorder.

Courtesy of Boris Birmaher, MD.

Graphic 131371 Version 1.0

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Differential diagnosis of pediatric mania*