Q:  Premature Birth & BP Diagnosis:
      Neurological Impairments Mimic BP and/or ADHD?

My sister has an 8 year old daughter who was born 3 months premature. She has been treated for ADHD since at least the age of 5. Recently her doctor changed her diagnoses to Bi-Polar. I'm wondering how much of a role her premature birth plays in the Bi-Polar diagnoses she now has. She does have neurologitcal impairments...I'm wondering if these impairments could mimic Bi-polar and/or ADHA.

Dear Ms. M' -- 
ADHD and bipolar disorder can look very similar (there's a table, in linked essay, that compares the two). We know that injury during childbirth ("perinatal complications") are statistically associated with developing bipolar disorder, though usually many years later than your niece.  Could she actually have neurological impairments that just "look like" bipolar (or ADHD) and not really have "bipolar disorder"? If I heard correctly that you might be wondering that, and wondering whether therefore the medications for bipolar disorder could be unhelpful or unnecessary or at least off-target... I'm sorry I can't help you there because I'm not enough of a specialist in that area to know how often this apparent overlap might occur.  Often even if there is a "neurologic" basis (a funny idea, as all of the symptoms we deal with ultimately have a neurologic basis) that's not "really" bipolar, we end up treating it as though it is bipolar, because we have to treat the symptoms somehow, and the neurologists, even if they can say "yes, this is an effect of the birth trauma" don't necessarily have a specific fix that comes from that diagnosis.  Instead, somebody has to treat the symptoms and that often ends up being a psychiatrist.  Not that the neurologist input isn't helpful though: sometimes it helps a lot to have a firm statement of "this is where the problem came from".  We could use that in a lot of our psychiatric conditions, certainly. 

Dr. Phelps