Comorbidity with ADHD decreases response to pharmacotherapy in children and adolescents with acute mania:: Evidence from a metaanalysis

Objective: To assess whether comorbid attention-deficit hyperactivity disorder (ADHD) influences response to treatment in young patients with acute mania. Methods: We conducted a metaanalysis of 5 open trials of 100, 35, 41, 60, and 37 children and adolescents. The pooled group included 273 children and adolescents with bipolar disorder (BD), divided into 2 subgroups: those with (n = 132), and those without (n = 14 1), ADHD comorbidity. Results: There was a moderate and significant reduction in relative risk (RR) favouring treatment response in children and adolescents with BD but without ADHD comorbidity (RR 0.822; 95%Cl, 0.69 to 0.97; P = 0.021). The negative effect of ADHD comorbidity on treatment response was more significant in studies including adolescents only or subjects with BD I only. Conclusion: These findings suggest that children and adolescents with BD and ADHD tend to be less responsive to drugs used in treatment of acute mania.