What questions should be asked of a teenage girl with a history of depression and attention‑deficit/hyperactivity disorder to screen for bipolar disorder?

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Last updated: March 10, 2026 • View editorial policy

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Screening Questions for Bipolar Disorder in a Teen Girl with Depression and ADHD

Ask specifically about distinct episodes of mood changes with decreased need for sleep and increased psychomotor activation—these are the core screening questions that differentiate bipolar disorder from depression and ADHD alone. 1

Essential Screening Questions

Primary Mood Episode Questions

Focus your screening on identifying distinct, spontaneous periods rather than chronic baseline symptoms:

  • "Have you ever had times lasting several days when your mood was very different from usual—either extremely happy/excited or extremely irritable—that was clearly different from your normal self?"

    • This targets episodic changes, not just irritability which overlaps with ADHD 1

  • "During those times, did you need much less sleep than usual but still felt full of energy or not tired?"

    • Decreased need for sleep (not just insomnia) is a hallmark sign and helps distinguish from ADHD-related sleep problems 1

  • "Did your thoughts race so fast you couldn't keep up with them, or did you talk much more or faster than usual?"

    • Racing thoughts and pressured speech indicate cognitive changes beyond ADHD distractibility 1

Associated Symptom Questions

During those distinct mood episodes, ask about:

  • Increased goal-directed activity or psychomotor agitation that was markedly worse than her baseline ADHD symptoms 1
  • Grandiose thoughts (feeling special powers, unrealistic abilities beyond normal confidence)
  • Reckless behaviors that were uncharacteristic (hypersexuality, spending sprees, dangerous activities)
  • Marked mood lability during the same episode (rapid shifts between euphoria and irritability) 1

Critical Contextual Questions

Duration and Pattern

  • "How long did these episodes last?"
    • True mania requires ≥7 days; hypomania ≥4 days
    • Episodes lasting hours to <4 days suggest Bipolar NOS, not classic bipolar disorder 1

Functional Impact

  • "Was this change noticeable to others at home AND at school?"

    • Must be evident across multiple settings, not context-dependent like ADHD symptoms 1

  • "Was this a clear change from how you normally are, not just your usual personality?"

    • Distinguishes episodic illness from temperamental traits 1

Depression History

  • "When you've felt depressed, did you sleep much more than usual and feel slowed down physically?"

    • Bipolar depression often presents with psychomotor retardation and hypersomnia 1

  • "Did your depression come on suddenly and severely?"

    • Rapid onset with psychotic features predicts bipolar course 1

Family and Treatment History

  • "Does anyone in your biological family have bipolar disorder or severe mood problems?"

    • Four- to sixfold increased risk with first-degree relatives 1

  • "Have antidepressants ever made you feel 'wired,' overly energetic, or caused racing thoughts?"

    • Antidepressant-induced hypomania/mania is a strong predictor of bipolar disorder 1

Critical Pitfalls to Avoid

Do not diagnose bipolar disorder based on:

  • Chronic irritability alone—this overlaps heavily with ADHD and lacks specificity 1, 2
  • ADHD symptoms (distractibility, high energy, impulsivity) at baseline—only count these as manic symptoms if markedly increased during a distinct mood episode 2
  • Emotional reactivity to situations—bipolar mood changes are spontaneous, not purely reactive 1

Key distinction: In ADHD with depression, symptoms are relatively chronic and context-dependent. In bipolar disorder, there are distinct episodes representing a marked departure from baseline functioning, with sleep disturbance being the most reliable differentiator 1.

Additional Risk Assessment

Given her depression history, also screen for:

  • Suicidality (adolescents with bipolar disorder have high suicide attempt rates) 1
  • Substance use (highly comorbid with bipolar disorder) 1
  • Psychotic symptoms during mood episodes 1

The presence of episodic mood changes with decreased sleep need, occurring across multiple settings, and representing clear departure from baseline strongly suggests bipolar disorder rather than depression with ADHD alone 1.

References

1
Guideline

practice parameter for the assessment and treatment of children and adolescents with bipolar disorder.

Journal of the American Academy of Child and Adolescent Psychiatry, 2007

2
Research

Practitioner review: the assessment of bipolar disorder in children and adolescents.

Journal of child psychology and psychiatry, and allied disciplines, 2009

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.