Conditions That Can Produce ADHD-Like Symptoms

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, having ADHD does increase the risk for the development of other 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 a listing 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.

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.

On the other hand, as mentioned previously, 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. Again, 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.

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.

_{ADHD: A Complete and Authoritative Guide. Edited by Michael I. Reiff, MD, FAAP with Sherill Tippins. American Academy of Pediatrics. 2004.}

_{ADHD Comorbidities: Handbook for ADHD Complications in Children and Adults. Edited by Thomas E. Brown, Ph.D. American Psychiatric Publishing, Inc. 2009.}