Conditions That Mimic ADHD

ADHD is defined by its symptoms (rather than its cause)

The DSM-V (the guide that lays out the criteria to be used by doctors, mental health professionals, and other qualified clinicians when making a diagnosis of ADHD) lists ADHD in the category of ‘Neurodevelopmental Disorders’ and defines it as:

“a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with development, has symptoms presenting in two or more settings (e.g. at home, school, or work), and negatively impacts directly on social, academic or occupational functioning”

If you look at Getting a Diagnosis you will notice there is a checklist of symptoms from which children must have at least six symptoms from either, or both categories, while older adolescents and adults (over age 17 years) must present with five.

Care must be taken to rule out other conditions that may mimic ADHD

Symptoms of hyperactivity, distractibility, impulsivity, inattention and so on may be all too real but, before attributing them to ADHD and treating as ADHD accordingly, it would be wise to explore some other conditions that may result in ADHD symptoms.

This is a difficult task because many ADHD diagnoses are often accompanied by a co-morbid condition diagnosis such as anxiety.

Conditions That Mimic ADHD

If these conditions are diagnosed and treated it may be that the symptoms associated with ADHD disappear as a result.

Receiving the correct treatment for the correct diagnosis, as early as possible, is vital as misdiagnosis can result in a delay or lack of appropriate treatment with significant impact on an individual.

Co-Morbid Conditions

The conditions that are also co-morbid are covered here.

Biochemical Imbalances

Examples include:

• High copper levels → hyper-excitability of the nervous system
• Low zinc → decreases regulation of GABA, a calming neurotransmitter

Proper copper/zinc balance can improve symptoms of inattention and lack of focus.

• Yeast toxicity can also lead to poor focus, inattention, impulsivity and anxiety.

Reference [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661234/]

Foetal Alcohol Spectrum Disorder (FASD)

FASD results from alcohol exposure during pregnancy. Associated behaviours and challenges include:

• Learning difficulties
• Memory problems
• Impulsiveness
• Difficulty following instructions
• Difficulty with abstract thinking
• Hyperactivity
• Difficulty relating actions to consequences

Facial features associated with FASD:

• Short horizontal eye openings
• Smooth philtrum
• Thin upper lip

Food Intolerances & Sensitivities

Food sensitivities can worsen ADHD-like behaviours such as:

• Hyperactivity
• Impulsivity
• Lack of concentration

A 2011 study in The Lancet showed 64% of children on a restricted diet improved significantly, while none in the control group did.

Fragile X Syndrome

A genetic condition causing:

• Intellectual disability
• Behavioural and learning difficulties
• Physical characteristics

It’s the most common known single-gene cause of autism. Boys are usually more affected than girls.
Estimated that 5% of people with autism may have Fragile X.

Giftedness

Gifted children may mimic ADHD due to:

• Asking many questions (appears hyperactive)
• Getting bored with unchallenging work (appears inattentive)

Note: A child can be both gifted and have ADHD (this is referred to as 2E – Twice Exceptional).

Hearing Problems

Commonly mistaken for ADHD due to:

• Inattention or misheard instructions
• Appearing unfocused

Causes may include:

• Earwax blockages
• Ear infections
• Tinnitus
• Auditory Processing Disorder
• Congenital or acquired conditions

Consult your GP or ENT specialist for a hearing assessment.

Medical Conditions

Some medical conditions like thyroid dysfunction can mimic ADHD.

A study in Clinical Endocrinology found high TSH and low free T4 levels are associated with ADHD-type learning problems, even within normal ranges.

PANDAS

PANDAS stands for Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus.

Symptoms may include:

• Sudden onset of OCD
• Anxiety
• Behavioural issues
• New learning difficulties

It is believed to result from the immune system attacking parts of the brain after a strep infection.

Traumatic Brain Injury

ADHD-like symptoms may arise after a head injury, particularly in children.

• 20% of children with brain injury develop Secondary ADHD
• The more severe the trauma, the higher the risk

Vision Problems

Undiagnosed vision problems may lead to apparent inattention. Conditions include:

• Myopia (short-sightedness)
• Hyperopia (long-sightedness)
• Astigmatism
• Presbyopia
• Binocular vision issues
• Lazy eye
• Eye fatigue
• Colour blindness

These can often be identified with a simple eye test by an optometrist or ophthalmologist. Complex issues may require a behavioural optometrist.

References