Clinical and Genetic Correlates of Bipolar Disorder With Childhood-Onset Attention Deficit Disorder

Nicolas A. Nunez, Brandon J. Coombes, Francisco Romo-Nava, David J. Bond, Jennifer Vande Voort, Paul E. Croarkin, Nicole Leibman, Manuel Gardea Resendez, Marin Veldic, Hannah Betcher, Balwinder Singh, Colin Colby, Alfredo Cuellar-Barboza, Miguel Prieto, Katherine M. Moore, Aysegul Ozerdem, Susan L. McElroy, Mark A. Frye*, Joanna M. Biernacka

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Bipolar disorder (BD) with co-occurring attention deficit-hyperactivity disorder (ADHD) is associated with an unfavorable course of illness. We aimed to identify potential clinical and genetic correlates of BD with and without ADHD. Methods: Among patients with BD (N = 2,198) enrolled in the Mayo Clinic Bipolar Biobank we identified those with ADHD diagnosed in childhood (BD+cADHD; N = 350), those with adult-onset attention deficit symptoms (BD+aAD; N = 254), and those without ADHD (N = 1,594). We compared the groups using linear or logistic regression adjusting for age, sex, and recruitment site. For genotyped patients (N = 1,443), logistic regression was used to compare ADHD and BD polygenic risk scores (PRSs) between the BD groups, as well as to non-BD controls (N = 777). Results: Compared to the non-ADHD BD group, BD+cADHD patients were younger, more often men and had a greater number of co-occurring anxiety and substance use disorders (all p < 0.001). Additionally, BD+cADHD patients had poorer responses to lithium and lamotrigine (p = 0.005 and p = 0.007, respectively). In PRS analyses, all BD patient subsets had greater genetic risk for BD and ADHD when compared to non-BD controls (p < 0.001 in all comparisons). BD+cADHD patients had a higher ADHD-PRS than non-ADHD BD patients (p = 0.012). However, BD+aAD patients showed no evidence of higher ADHD-PRS than non-ADHD BD patients (p = 0.38). Conclusions: BD+cADHD was associated with a greater number of comorbidities and reduced response to mood stabilizing treatments. The higher ADHD PRS for the BD+cADHD group may reflect a greater influence of genetic factors on early presentation of ADHD symptoms.

Original languageEnglish
Article number884217
Pages (from-to)884217
JournalFrontiers in Psychiatry
StatePublished - 14 Apr 2022

Bibliographical note

Funding Information:
JV reports a grant-in-kind from Assurex, unrelated to the current study. PC has received research support from Neuronetics, Inc., NeoSync, Inc., and Pfizer. He has received grant-in-kind equipment and laboratory support for research studies from Assurex Health, Neuronetics, Inc. and MagVenture, Inc. He has served as a consultant for Myriad Neuroscience and Procter & Gamble. BS received grant support from Clinical and Translational Science CCaTS Small Grants Award, and Mayo Clinic. SM is or has been a consultant to or member of the scientific advisory boards of Avanir, Allergan now AbbVie, Bracket now Signant Health, Naurex, Idorsia, Intra-Cellular Therapies, Inc., Shire now Takeda, Sunovion, and Takeda. She is or has been a principal or co-investigator on studies sponsored by the Agency for Healthcare Research & Quality AHRQ, Avenir, AstraZeneca, Cephalon, Forest, Marriott Foundation, Medibio, National Institute of Mental Health, Orexigen Therapeutics, Inc., Jazz, Shire now Takeda, Sunovian, and Takeda Pharmaceutical Company Ltd. She is also an inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and along with the patent's assignee, University of Cincinnati, Cincinnati, Ohio, has received payments from Johnson & Johnson, which has exclusive rights under the patent. MF has received grant support from Assurex Health, Myriad, Pfizer, National Institute of Mental Health RO1 MH079261, National Institute of Alcohol Abuse and Alcoholism P20AA017830, Mayo Foundation; has been a consultant to Janssen Global Services, LLC, Mitsubishi Tanabe Pharma Corporation, Myriad, Sunovion, and Teva Pharmaceuticals; has received CME/Travel Support/presentation from CME Outfitters Inc. and Sunovian; Mayo Clinic has a financial interest in AssureRx and OneOme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher Copyright:
Copyright © 2022 Nunez, Coombes, Romo-Nava, Bond, Vande Voort, Croarkin, Leibman, Gardea Resendez, Veldic, Betcher, Singh, Colby, Cuellar-Barboza, Prieto, Moore, Ozerdem, McElroy, Frye and Biernacka.


  • ADHD
  • bipolar disorder
  • clinical features
  • genetic
  • polygenic risk score


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