What Conditions Might Be Confused With ADD?

The purpose of a comprehensive diagnostic evaluation is to rule-out other conditions which may present with symptoms that can look identical to the symptoms of ADD. Through careful questioning, observation, and objective testing these conditions can either be ruled out or described as co-existing with ADD. The following conditions are commonly confused with ADD.

Oppositional-Defiant Disorder

These children display a pattern of negativistic, hostile and defiant behavior. They tend to be argumentative, lose their temper frequently, and deliberately annoy or blame others. However, they typically lack the developmental delays and the pattern of impulsive, disinhibited behavior characteristic of children with ADD. They also do not display a marked degree of restlessness and inattentiveness.

This syndrome is often associated with parental difficulties with child management, a dysfunctional family setting or a history of depression in one or both parents.

Learning Disabilities

Children with learning disabilities must demonstrate a significant discrepancy between intellectual potential and academic achievement. They tend to lack the early childhood history of hyperactivity characteristic of ADD. Problems staying focused may arise when schoolwork becomes difficult, often in second or third grade. These attention problems are typically task-specific as opposed to the more global attention problems seen in children with ADD.

Anxiety/Panic Disorders

Rather than appearing impulsive, children with anxiety are frequently over-inhibited and shy. Although they may appear restless, this may look like fretful, worrisome behavior as opposed to hyperactivity. They may have difficulty focusing attention at specific times but can sustain attention if sufficiently relaxed. There tends to be a strong family history of anxiety. Interview information typically reveals no history of hyperactivity during early childhood.

Thought Disorders

Children with psychotic features display very atypical patterns of thinking. Parents may notice odd fascinations, strange aversions, unusual mannerisms and postures, and peculiar sensory reactions. They may appear labile and display unpredictable moods not tied to reality. Social aloofness and disinterest in others may be present. These children often have extreme difficulties relating to others and may have poor perception of the meaningfulness of events.

Other Psychiatric Disorders

A psychiatric evaluation or use of psychological tests which assess personality and mood may be necessary to differentiate ADD from the following conditions:

  • Affective disorders with manic characteristics
  • Major depression
  • Adjustment disorder with disturbance of behavior
  • Personality disorder
  • Obsesive-compulsive disorder

Organic/Medical Disorders

A medical examination and thorough health history should be included in the diagnostic process, as ADD–like symptoms can sometimes be attributed to physical causes besides ADD. The conditions which should be considered are:

  • Lead toxicity
  • Sensory disorders, especially hearing impairment
  • Medication-induced attentional difficulties (e.g., antihistamines)
  • Substance abuse
  • Attentional difficulties resulting from sleep disorders
  • Mental retardation
  • Seizure disorder
  • Hypothyroidism
  • Iron-deficiency anemia
  • Tourette’s disorder/multiple tic disorder

Inappropriate Envirionment/Expectations

In young children, inattention or overactivity may be age-appropriate. Inappropriate school placement or curriculum (i.e., a gifted child who is bored with the classroom work) may lead to ADD-like behaviors. Similarly, a chaotic home setting, abuse or neglect may result in behavioral symptoms.

What is ADD?
Classroom Modifications for ADD and ADHD
Counseling and Education for Children with ADD or ADHD
What Conditions Might Be Confused With ADD?
What Conditions Commonly Co-Exist With ADD?
How can you tell if a child is having trouble because of problems such as stress or family problems or if it’s really ADD?
How can you tell if a child with learning disabilities also has ADD?
National Resources for ADD and ADHD Information
Recommended Reading

Referring to this article:
“Attention Deficit Disorder: What is ADD?” was written by C. J. Newton, MA, Learning Specialist and published in the Find Counseling.com (formerly TherapistFinder.net) Mental Health Journal in July, 1997. Parts of the article were published at the ADD/LD Resource Center web site (www.add-ld.com), owned and operated by the Institute for ADD and Learning, in 1995. C. J. Newton was the co-founder of the Institute for ADD and Learning, along with Sandra Scheinbaum, Ph.D. That web site no longer exists.

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