In part 2 of my “Help- I think my kid has ADHD!” series, I wanted to talk about some of the other possible causes of behaviors or symptoms that while they may look like ADHD on the surface, could be caused by another condition. I hope part 1 (where I covered what ADHD is and how is it diagnosed) was helpful and provides some context for the following information.
Let’s start with what I mean by “look like” I am absolutely not suggesting that the behaviors we might see of inattentiveness or hyperactivity are not true. I’m suggesting that there are many things that can include these symptoms, and this overlap makes it so important that we come to the clear understanding of what is causing them.
Honestly, this is not even an exhaustive list, but off the top of my head here are a few of the more common things that might show up looking like ADHD:
1. Hearing problems- it’s hard to follow directions or be attentive if you cannot hear. In young kids, they may even lack the awareness that they can’t hear very well. Consider when your last hearing checkup was? Did you know that The American Academy of Pediatrics only recommends more regular hearing tests in around the ages of 4-10? Sure, physicians would do hearing checkups if there were obvious symptoms of hearing loss early on (e.g., speech delay), but if not, this could easily be missed!
2. Anxiety- this is probably what I see most commonly. If someone comes to me and says, “I feel like my thoughts are racing 1,000,000 miles an hour, and every time I sit down to do work I get anxious about if I’m going to do it wrong or what my boss will say. It’s hard for me to calm down and relax, and nothing seems to make it better. I feel like I’m never able to settle down…” one might think ADHD, but this is also clearly a possible anxiety disorder. More than some of these others I list here, ADHD and anxiety symptoms overlap so much and with that it’s important to keep an eye on our assumptions and avoid jumping to conclusions either way.
3. Depression- I find this one showing up more commonly with inattentive type ADHD. One of the common symptoms of depression is lacking interest in things … even things that you used to like or that seem like they should be fun. And if you’re not interested in anything, it’s easy to get distracted, daze off, and not pay attention.
4. Learning disorders or social struggles in school- when symptoms primarily show up in the learning environment, I’m always curious about what’s going on there. Are they having a hard time grasping educational material? Like adults, kids can use avoidance when they’re struggling with something. People typically resist things or dislike the things we feel like we’re not any good at. Similarly inattentiveness or even defiance to do things like school/homework can mask underlying learning disorders. Furthermore, is the child cutting up or being a class clown at school a way for them to seek attention and approval from peers? Are they trying to engage with peers but lacking the right skills to do so? These would be important pieces of information to know.
5. Trauma- another really important overlooked diagnosis and in fact this one really hurts me to think about. Not only for the technical elements of misdiagnosis, but the likely missed opportunity to seek needed mental health care, creating a possibility for unresolved trauma to ensue. Common trauma symptoms that we see include things like difficulty concentrating, feeling distracted, overwhelmed or disorganized by all that there is going on. It’s also common for trauma survivors to describe feeling restless (difficulty relaxing) or have trouble sleeping. Another that stands out to me is a symptom called rumination. In simple terms, I described this as that experience as something like “chewing on your thoughts over and over.” When that’s happening, it’s hard to focus on anything else!
We know that ADHD is one of the most common misdiagnosed disorders in the medical and mental health fields. Rough estimates suggest that perhaps as many as 20% of all those diagnosed with ADHD are misdiagnosed, which is crazy high. Why do misdiagnoses happen? Well, it’s complicated and not a simple or straightforward answer. What I do know is how can we prevent and/or reduce misdiagnosis. By using a collaborative approach between all sorts of medical and mental health professionals, we can rule out some of these conditions listed above, and laser in to really understand what’s going on and how to best help.
Next up in the series? What does a good ADHD evaluation look like. 🙂
– Dr. M
P.S. – If you are ready to take next steps to get ADHD Therapy or Assessment, Contact Me.