Misdiagnosis of Attention Deficit Hyperactivity Disorder


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People are diverse, and so are their behaviors, emotions, and beliefs. This is one of the problems for diagnosis of ADHD in children and adolescents according to their hyperactive or inattentive behaviors. However, at what point in the range of behavior is a "hyperactive" child actually suffering from clinical hyperactivity. Similarly, some children who are "dreamy" or "shy" do not necessarily have clinical inattention syndromes. The use of Ritalin as a drug to medicate hyperactive children is a controversial issue, where many believe that a large number of actually normal children are being over-diagnosed with ADHD and given unnecessary medication.

About misdiagnosis: When checking for a misdiagnosis of Attention Deficit Hyperactivity Disorder or confirming a diagnosis of Attention Deficit Hyperactivity Disorder, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. These alternate diagnoses of Attention Deficit Hyperactivity Disorder may already have been considered by your doctor or may need to be considered as possible alternative diagnoses or candidates for misdiagnosis of Attention Deficit Hyperactivity Disorder. For a general overview of misdiagnosis issues for all diseases, see Overview of Misdiagnosis.

Alternative diagnoses list for Attention Deficit Hyperactivity Disorder: For a diagnosis of Attention Deficit Hyperactivity Disorder, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Attention Deficit Hyperactivity Disorder:

Attention Deficit Hyperactivity Disorder as an alternative diagnosis: The other diseases for which Attention Deficit Hyperactivity Disorder is listed as a possible alternative diagnosis in their lists include:

Discussion of diagnosis/misdiagnosis of Attention Deficit Hyperactivity Disorder: Behaviors can be judged as normal or "problem" by evaluating them in relation to the person's age and developmental maturity. For example, the same behaviors that are acceptable in a 5-year old may be problematic for a 10-year old. Problem behaviors are also long lasting, tend to occur more often and create more problems as time goes on. Children with ADHD will have more problems than other children their age experience in the same settings. 1

Many girls and women with ADHD are often undiagnosed because their symptoms look different from those in boys or men. Many girls or women may not appear hyperactive. Girls are usually less rebellious, less defiant and generally considered less difficult than boys. Boys who are hyperactive and disorganized are easier to spot and more likely to be referred for an evaluation.

There are several personality types of girls in which ADHD could be a factor. For example, there are girls who are shy and withdrawn, but disorganized. There are girls who are "tomboys," who are drawn to risky activities. They may be cooperative at school and work hard to please parents and teachers, but are often disorganized and messy. There are "daydreamers" or girls who seem to listen to teachers in class, but be in another world. They may find their minds wandering, are forgetful and disorganized. They become very anxious, depressed, worried and overwhelmed when schoolwork is due. They often are thought to be less bright than they actually are. "Chatty" girls also have high activity levels, and are very talkative and emotional, but can be forgetful and disorganized. Highly intelligent girls, with above average IQs, who have increasing problems with concentration and organization as their school life becomes more demanding also may have ADHD.

Women with ADHD who complain of feeling overwhelmed and disorganized tend to be diagnosed more often with depression. These women often feel a powerful sense of shame and inadequacy. They oftentimes need to spend all of their waking energy just fighting their natural tendency to be disorganized. Sometimes, ADHD does not become a problem until a woman has a baby or a second baby, when she is expected to be highly organized, accomplishing multiple roles under a lot of strain as both a caregiver and, in many cases, a career woman. 1

Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn't mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD? 2

The fact is, many things can produce these behaviors. Anything from chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive. For example, a formerly cooperative child who becomes overactive and easily distracted after a parent's death is dealing with an emotional problem, not ADHD. A chronic middle ear infection can also make a child seem distracted and uncooperative. So can living with family members who are physically abusive or addicted to drugs or alcohol. Can you imagine a child trying to focus on a math lesson when his or her safety and well-being are in danger each day? Such children are showing the effects of other problems, not ADHD.

In other children, ADHD-like behaviors may be their response to a defeating classroom situation. Perhaps the child has a learning disability and is not developmentally ready to learn to read and write at the time these are taught. Or maybe the work is too hard or too easy, leaving the child frustrated or bored. 2

It's also important to realize that during certain stages of development, the majority of children that age tend to be inattentive, hyperactive, or impulsive--but do not have ADHD. Preschoolers have lots of energy and run everywhere they go, but this doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized, and reject authority. It doesn't mean they will have a lifelong problem controlling their impulses. 2

What Can Look Like ADHD?

  • Underachievement at school due to a learning disability
  • Attention lapses caused by petit mal seizures
  • A middle ear infection that causes an intermittent hearing problem
  • Disruptive or unresponsive behavior due to anxiety or depression
2

For example, heavy alcohol use during pregnancy has been linked to fetal alcohol syndrome (FAS), a condition that can lead to low birth weight, intellectual impairment, and certain physical defects. Many children born with FAS show much the same hyperactivity, inattention, and impulsivity as children with ADHD. 2

Whatever the specialist's expertise, his or her first task is to gather information that will rule out other possible reasons for the child's behavior. In ruling out other causes, the specialist checks the child's school and medical records. The specialist tries to sense whether the home and classroom environments are stressful or chaotic, and how the child's parents and teachers deal with the child. They may have a doctor look for such problems as emotional disorders, undetectable (petit mal) seizures, and poor vision or hearing. Most schools automatically screen for vision and hearing, so this information is often already on record. A doctor may also look for allergies or nutrition problems like chronic "caffeine highs" that might make the child seem overly active. 2

Another debate is whether Ritalin and other stimulant drugs are prescribed unnecessarily for too many children. Remember that many things, including anxiety, depression, allergies, seizures, or problems with the home or school environment can make children seem overactive, impulsive, or inattentive. Critics argue that many children who do not have a true attention disorder are medicated as a way to control their disruptive behaviors. 2

A child or adolescent who appears to be depressed and exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in bipolar disorder, particularly if there is a family history of the illness. This evaluation is especially important since psychostimulant medications, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania. 3

Medical news summaries about misdiagnosis of Attention Deficit Hyperactivity Disorder: The following medical news items are relevant to misdiagnosis of Attention Deficit Hyperactivity Disorder:

Misdiagnosis cases for Attention Deficit Hyperactivity Disorder: No cases available yet.

Footnotes:
1. excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC
2. excerpt from Attention Deficit Hyperactivity Disorder: NIMH
3. excerpt from Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH

Last revision: July 1, 2003

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