ADHD and Other Conditions: Look-Alikes and Common Companions

Many disorders and conditions can produce symptoms that look like ADHD. A child with a sleep disorder may struggle to focus or remember; a child with anxiety may squirm and fidget. For some children, another diagnosis explains the symptoms better — but many children with ADHD also have a second condition, such as behavior or conduct problems, a learning disorder, anxiety or depression. The American Academy of Pediatrics recommends that every child with ADHD be screened for other disorders and concerns.

Is it ADHD?

Symptoms that look like ADHD, or like another condition, are sometimes temporary — a reaction to stress or change:

• Coping with a big life change, such as losing a loved one, is hard, especially for a child already struggling to manage behavior and emotions.
• A move to a new home or school can make a child more distracted or fidgety. If the child doesn't settle quickly, it can be hard for parents to tell whether it is temporary stress or a problem that needs treatment.

On the other hand, ADHD without the right treatment and support can itself lead to other problems, such as behavior problems, anxiety or depression, that grow out of the challenges ADHD brings. A child with ADHD who develops new problems over time may need another evaluation.

"Complex ADHD"

Some children have symptoms beyond the typical picture of ADHD, known as "complex ADHD," and may need treatment suited to their particular needs. It can also mean ADHD that doesn't fit the usual ages — symptoms before age 4, or none until adolescence — which may call for more detailed diagnosis and treatment. Experts recommend that primary care providers refer a child to a specialist when they find conditions they are not experienced in diagnosing or treating.

The disorders that most often occur alongside ADHD are:

• anxiety;
• autism spectrum disorder;
• depression;
• disruptive behavior disorders;
• substance use disorders;
• tic disorders.

Behavior or conduct problems

All children are sometimes angry or defiant with adults, or lash out when upset. When the behavior lasts or is severe, it can become a behavior disorder. Children with ADHD are more likely than others to be diagnosed with one, such as oppositional defiant disorder or conduct disorder.

Learning disorders

A learning disorder means a clear difficulty in one or more areas of learning even though intelligence is not affected. Together, ADHD and a learning disorder can make school especially hard, so diagnosing each properly matters. Because children with ADHD often struggle in school, the first step is a careful evaluation of whether a learning disorder is also involved; schools usually do their own testing. A learning disorder can qualify a child for specialized instruction and special education services, and parents, health care providers and the school can work together on referrals and treatment.

Anxiety and depression

Every child has fears and worries, but when they are so many that they interfere with school, home or play, it is an anxiety disorder. Every child is sometimes sad, but persistent sadness and hopelessness cause problems. Children with ADHD are more likely than other children to develop an anxiety disorder or depression — especially when they can't control their symptoms and those symptoms get in the way of schoolwork or relationships with family and friends.

What parents can do

If a child's behavior or emotions are severe or last a long time, talk with the child's health care provider to get a complete and accurate diagnosis and treatment. The provider may refer the family to a child psychologist, child psychiatrist or developmental pediatrician, or recommend a developmental and educational evaluation (a "Child Find" evaluation) — through a local early intervention agency for children under 3, or the public school for children 3 and older.

• Behavior therapy, and specifically parent training in behavior management, is part of treatment for ADHD and many other developmental disorders. Parents learn skills to help with the specific symptoms causing difficulty.
• Talk with teachers. Accommodations and special education services can be tailored to the child's symptoms.

The National Resource Center on ADHD offers information and support.

Sources

• Centers for Disease Control and Prevention: "Other Concerns and Conditions with ADHD."