When a child is hyperactive, fidgety, impulsive, and struggles with issues of attention, one cannot automatically assume that this child has attention deficit hyperactivity disorder or ADHD. There are a number of other conditions and factors that can cause symptoms and behaviors that may be mistaken for ADHD. Pinpointing the causes of a child's impairment is vital to that child's improvement. Accurate diagnosis of a problem leads to effective treatment. This is why it is so important for an assessment of ADHD to be extremely thorough and comprehensive, and why clinicians need to use an empirically validated approach.
During the evaluation process, alternative explanations that might better account for the presence of ADHD-like behavior patterns must be ruled out before arriving at an ADHD diagnosis. To complicate the diagnostic and treatment process further, 60-100% of children who have ADHD may have co-morbid conditions, such as anxiety, depression, disruptive behavior disorders, learning disabilities, sleep problems, and even substance abuse. All of this must be taken into account when developing treatment plans. Below is alisting of several conditions that can produce symptoms in both children and adults that may be mistaken for ADHD.
There are a number of situational factors in one's environment that can result in problems that may look like ADHD. This may include when there is a lot of stress or a sudden life change, such as a move to a new home or a new school; a divorce or change in family configuration, such as remarriage; a death of someone close; financial difficulties; even the birth of a new baby. A chaotic or neglectful home environment, parental/marital conflict, inconsistent parental discipline, being bullied, witnessing or experiencing violence or abuse—all these stressors can impact a person's emotional and mental well-being and lead to problems with distraction, inattention, restlessness, hyperactivity, and "acting out" behaviors that can resemble, but have nothing to do with, ADHD.
Additionally, sleep disturbances can have a profound effect on one's ability to focus. Lack of sleep can result in hyperactivity; irritability; slower visual, auditory, sensory and motor reaction times; mental slowness; impaired learning of information and decreased school performance. Insufficient sleep is also associated with increased frequency of risk-taking behaviors in teens, such as smoking, drinking alcohol, and taking drugs. The reasons for a child's or an adult's sleep disturbances can range from poor sleep hygiene (sleep habits) to medical conditions that disrupt the sleep cycle, such as sleep apnea, restless legs syndrome, and other sleep disorders.
Mental Health Issues
Anxiety can result in restlessness, an inability to concentrate, impulsive reactions, and hyperactive behaviors. This anxiety can make it extremely difficult for a child or adult to sit still and control fidgeting. Sleep can be affected. It can be challenging to remain focused and complete tasks. These are all symptoms that can resemble ADHD but may be unrelated.
Similarly, depression may result in difficulty with focus, forgetfulness, low motivation, problems in making decisions, trouble getting started on and completing tasks, lethargy and sluggishness, disorganization, and sleep difficulties. The disruptive behaviors and poor impulse control associated with oppositional defiant disorder and conduct disorder can also look like ADHD.
Anxiety, depression, and disruptive behavior disorders (as well as many of the conditions listed here) commonly occur alongside ADHD. Each may be a separate disorder with distinct etiology and treatment needs, or each may be a secondary condition that develops as a result of the problems associated with ADHD.
This is why assessments of ADHD must gather and integrate specific information about the emotional functioning of a person, rather than focusing exclusively on the more overt disruptive behavioral symptoms.
Symptoms of bipolar disorder, including high energy level, excessive talking, racing thoughts that make it difficult to concentrate, impulsive decision-making, risk-taking, and intrusive behaviors, can also be confused with symptoms of ADHD.
Attention and concentration problems associated with individuals who have obsessive-compulsive disorder (OCD) may appear to be ADHD-related, but when delving deeper, a clearer picture emerges—attention problems may be related to "overfocusing" and problems in shifting attention may be due to obsessive thinking. A person with OCD may be slower to start and complete tasks because of the compulsive behaviors and rituals that must be completed before beginning.
ADHD can be a risk factor for substance abuse. Cigarette smoking as a youth with ADHD is often considered a gateway to marijuana, as well as alcohol and other drug abuse. A person who is abusing drugs and/or alcohol can also have behavioral symptoms that mimic ADHD. Those symptoms can include difficulty concentrating, problems with memory, restlessness, irritability, talkativeness, sleep problems, moodiness, and academic or work failures.
Children and adults on the autism spectrum can also display symptoms that resemble ADHD. They may become overexcited, hyperactive, and impulsive in stimulating environments, tend to focus on only those things that interest them, have trouble shifting focus, struggle to understand social cues and boundaries and experience social impairments.
High motor activity and problems with inhibition are common characteristics of both tic disorders and ADHD. The fidgeting, motor movements, and random noises may "look" similar to ADHD, but tics are defined by rapid, repeated, identical movements of the face or shoulders, or vocal sounds or phrases.
What Is Anxious ADD?
Learning Issues and Processing Problems
Similar to a person with ADHD, someone with a learning disability may struggle with issues of attention and have difficulty processing, organizing, remembering and learning information. Learning disabilities in reading, written language, and mathematics can all interfere with academic functioning, as can speech and language impairments and auditory and visual processing disorders.
ADHD and specific learning disorders often occur together, but they are separate conditions.
A child who is gifted academically and is not challenged within the classroom may even display behaviors that are similar to ADHD as he or she becomes bored with the curriculum—becoming inattentive, and/or impatient and disruptive. Along these same lines, a poor educational fit, or a classroom with a pervasive negative climate, a non-stimulating, un-motivating curriculum, or ineffective classroom management, all can lead to behaviors that look like but may be unrelated to, ADHD.
Certain medical conditions, including seizures, thyroid disease, allergies, iron deficiency anemia, and chronic ear infections, as well as hearing and vision impairments, can cause a person to have problems with attention, appear "day-dreamy," and become irritable, impulsive, or hyperactive. Certain medications can even result in ADHD-like behavior.
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By Keath Low
Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.
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- Bipolar disorder.
- Low blood sugar levels.
- Sensory processing disorder.
- Sleep disorders.
- Hearing problems.
- Kids being kids.
- Hearing problems. If you can't hear well, it's hard to pay attention — and easy to get distracted. ...
- Learning or cognitive disabilities. ...
- Sleep problems. ...
- Depression or anxiety. ...
- Substance abuse.
Differential diagnosis – The differential diagnosis for ADHD includes developmental variations, neurologic or developmental conditions, emotional and behavioral disorders, psychosocial or environmental factors, and certain medical problems (table 1).
About one-fifth of kids with ADHD also have some type of anxiety disorder, including separation anxiety, social anxiety, or general anxiety. And children with ADHD are more likely than others to get anxiety.
Doctors can misdiagnose ADHD in children due to their age. In fact, children who start school at a younger age more frequently receive a diagnosis of ADHD. If a child starts school having just turned 5 years old while some of their peers are closer to 6 years old, there is an approximate 20% difference in age.
Possibly the most common comorbid condition with ADHD is SUD, particularly alcohol and/or nicotine, cannabis and cocaine use . Substance abuse or dependency is approximately twice as common in individuals with ADHD as it is in the general population .
To diagnose ADHD, your child should have a full physical exam, including vision and hearing tests. Also, the FDA has approved the use of the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, a noninvasive scan that measures theta and beta brain waves.
ADHD paralysis is used to describe the overwhelm-shutdown process that can happen when you live with ADHD. When too many things are happening, or too many emotions are building, you may “freeze” as a way of responding to the stress.
All criteria must be met for a diagnosis of ADHD in adults1:
Five or more symptoms of inattention and/or ≥5 symptoms of hyperactivity/impulsivity must have persisted for ≥6 months to a degree that is inconsistent with the developmental level and negatively impacts social and academic/occupational activities.
These conditions are very common in children and adults who have ADHD. But they can sometimes get mixed up, too. When children are tired, they often do things that can look like ADHD, such as being hyperactive or impulsive, being aggressive, or acting out.
Doctors often mistake ADHD symptoms in adults for mood disorders, anxiety, obsessive-compulsive disorder, and other conditions with overlapping symptoms.
ADHD is an inaccurate — and potentially corrosive — name. The term “deficit disorder” places ADHD in the realm of pathology, or disease. Individuals with ADHD do not have a disease, nor do they have a deficit of attention; in fact, what they have is an abundance of attention.