A mom brings her 13-year-old daughter to the PMHNP for an evaluation of suspected attention-deficit hyperactivity disorder (ADHD). For an adolescent who presents with distractibility, which of the following additional features would suggest an association with bipolar II disorder rather than ADHD?

Choice A reason: Reduced need for sleep is a hallmark feature of hypomanic episodes in bipolar disorder and is not typical of ADHD. Choice B reason: Symptoms that occur episodically rather than consistently over time suggest a mood disorder rather than a chronic condition like ADHD. Choice C reason: Rapid speech can occur in both ADHD and hypomanic episodes, making it less specific. Choice D reason: Racing thoughts are characteristic of hypomanic episodes in bipolar disorder, helping distinguish it from ADHD.