If your child seems hyperactive--fidgety, impulsive, and inattentive--don't automatically assume that they have attention deficit hyperactivity disorder (ADHD). Anxiety, depression, learning disorders, physical health, and many other conditions can cause symptoms that look like ADHD but aren't.
The Importance of Testing and Accurate Diagnosis
ADHD and many conditions like it improve in many people with early intervention. This makes accurate, thorough testing and evaluation using an empirically validated approach so important.
During the evaluation process, the healthcare provider must rule out alternative explanations that might better account for ADHD-like behavior before arriving at an ADHD diagnosis.
To complicate things further, an estimated 60-100% of children with ADHD have comorbid conditions such as anxiety, depression, behavior issues, learning disabilities, sleep problems, and substance abuse. All of this must be accounted for in your child's treatment plan, which must be tailored to their needs and diagnosis.
Environmental Conditions
Stress or a sudden life change, such as a move, parents' divorce, a death, financial difficulties, and even a new sibling, can evoke ADHD-like behaviors.
Likewise, neglect, parental/marital conflict, inconsistent discipline, bullying, abuse, and other stressors can negatively affect a child's emotional and mental health. This can lead to distraction, inattention, restlessness, hyperactivity, and "acting out" behaviors that can resemble, but have nothing to do with, ADHD.
Sleep Problems
Sleep disturbances can have a profound effect on the ability to focus. Other issues can include:
- Hyperactivity
- Irritability
- Slowed visual, auditory, sensory, and motor reaction times
- Mental slowness
- Impaired learning of information
- 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 sleep disturbances can range from poor 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 manifest as restlessness, an inability to concentrate, impulsive reactions, and hyperactive behaviors. This anxiety can make it extremely difficult to sit still and control fidgeting. Adverse mental health also affects sleep, in turn resulting in the sleep issues mentioned above. These are all symptoms that can resemble ADHD but may be unrelated.
Similarly, depression can cause lack of focus, forgetfulness, low motivation, indecisiveness, 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 also can look like ADHD.
Anxiety, depression, and disruptive behavior disorders (as well as the conditions listed here) commonly occur alongside ADHD. Each can 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 emotional functioning, rather than focusing exclusively on the overt disruptive behavioral symptoms.
Bipolar Disorder
Symptoms of bipolar disorder, including high energy level, excessive talking, racing thoughts that make it difficult to concentrate, impulsivity, risk-taking, and intrusive behaviors, can also be confused with symptoms of ADHD.
Obsessive-Compulsive Disorder
Attention and concentration problems associated with 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 finish tasks because of the compulsive behaviors and rituals that they must complete first.
Substance Misuse
ADHD has been associated with a risk for substance misuse. A person who is misusing 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 difficulties.
Autism
Children and adults on the autism spectrum can have 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 hint at ADHD, but tics are defined by rapid, repeated, identical movements of the face or shoulders, or vocal sounds or phrases.
Autism vs ADHD: What Are the Differences?
Learning Issues and Processing Problems
Similar to a person with ADHD, someone with a learning disability may struggle with issues of attention, processing, organizing, remembering and learning. Learning disabilities in reading, written language, and mathematics interfere with academic functioning, as can speech and language impairments and auditory and visual processing disorders.
ADHD and learning disorders often occur together, but they are separate conditions.
A child who is gifted academically and is not challenged in the classroom might display ADHD-like behaviors out of boredom, becoming inattentive, impatient, and disruptive. The same issues also can result from a poor educational fit or a classroom with a pervasive negative climate, a non-stimulating curriculum, or ineffective management.
Medical Conditions
Certain medical conditions, including seizures, thyroid disease, allergies, iron-deficiency anemia, chronic ear infections, and hearing/vision impairments can cause problems with attention, irritability, impulsivity, or hyperactivity. Even certain medications can trigger ADHD-like behavior.
A Word From Verywell Mind
Naming a problem is often the first, most important step in attending to it. A host of other conditions can mimic ADHD, each requiring a different treatment protocol. If you think your child might have ADHD, seek out a reputable psychologist who will provide thorough, accurate testing to pin down the issue--and ultimately, help your child achieve their potential.
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