Q. My son is 13 years old and was diagnosed with bipolar and severe ADHD at age 7. Recently during one of the counseling sessions, our therapist suggested that my son also suffers from Asperger Syndrome. It was surprising to me that he would say that because before my son was diagnosed with bipolar disease, my husband and I had heard of Asperger's and had done some research and thought most of the symptoms were related to my son. But at the time, the doctor said she did not believe that was the case because my son showed affection very easily. Are there many cases of comorbidity with bipolar and Asperger's Syndrome?

A. It's too early to answer your question precisely, but there is growing evidence that bipolar disorder and Asperger-type syndromes occur together more frequently than chance alone would predict. Because Asperger's Syndrome--actually called Asperger's Disorder (AD) in the DSM-IV-is a relatively new diagnostic category, the required studies to answer your question have not been done. However, in one study by Wozniak et al (J Am Acad Child Adolesc Psychiatry 1997;36:1552-60), 14 of 52 children with pervasive developmental disorders (including AD) also met criteria for bipolar disorder.

The diagnosis is sometimes very difficult in such children, since kids with autistic spectrum disorders may show mood shifts in response to minor changes in their environment (as you may well know!) The selection of treatment agents for children with both AD and bipolar disorder--not to mention ADHD--requires very careful evaluation. For a more detailed discussion of these issues, I recommend your reading the excellent case conference by Frazier et al, in the January 2002 issue of the American Journal of Psychiatry.

You may also want to consider the option of obtaining a second opinion from an expert in child development, if you have any concerns about your therapist's conclusion.

November 2002

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