Attention-Deficit/Hyperactivity Disorder

ADHD Symptoms in Children and Adolescents
as cited in the Diagnostic & Statistical manual of Mental Disorders [DSM-IV]

Symptoms of Inattentiveness

1)    can’t pay close attention to details, or makes careless mistakes
2)    has difficulty paying attention or is easily distracted
3)    has trouble organizing tasks
4)    doesn’t follow through on instructions, or fails to finish things (but not because he can’t understand the instructions)
5)    doesn’t listen when spoken to directly
6)    forgets things, or loses things like toys
7)    avoids or dislikes tasks that require continuous mental effort, like homework

Symptoms of Hyperactivity-Impulsivity

1)    blurts out answers or talks a lot
2)    fidgets, squirms, or can’t stay in his seat
3)    has trouble playing quietly
4)    has difficulty waiting to take turns
5)    acts as if “driven by a motor”
6)    interrupts or intrudes on others
7)    runs or climbs excessively in inappropriate situations

Differential diagnosis
as cited in the Diagnostic & Statistical manual of Mental Disorders [DSM-IV]

In early childhood, it may be difficult to distinguish symptoms of Attention-Deficit/Hyperactivity Disorder from age-appropriate behaviors in active children (e.g., running around or being noisy).

Symptoms of inattention are common among children with low IQ who are placed in academic settings that are inappropriate to their intellectual ability.  These behaviors must be distinguished from similar signs in children with Attention-Deficit/Hyperactivity Disorder.  In children with Mental Retardation, an additional diagnosis of Attention-Deficit/Hyperactivity Disorder should be made only if the symptoms of inattention or hyperactivity are excessive for the child’s mental age.  Inattention in the classroom may also occur when children with high intelligence are placed in academically understimulating environments.

Attention-Deficit/Hyperactivity Disorder must also be distinguished from difficulty in goal-directed behavior in children from inadequate, disorganized or chaotic environments.  Reports from multiple informants (e.g., babysitters, grandparents or parents of playmates) are helpful in providing a confluence of observations concerning the child’s inattention, hyperactivity and capacity for developing mentally appropriate self-regulation in various settings.

Individuals with oppositional behavior may resist work or school tasks that require self-application because of an
unwillingness to conform to others’ demands.  These symptoms must be differentiated from the avoidance of school tasks seen in individuals with Attention-Deficit/Hyperactivity Disorder.  Complicating the differential diagnosis is the fact that some individuals with Attention-Deficit/Hyperactivity Disorder develop secondary oppositional attitudes towards such tasks and devalue their importance, often as a rationalization for their failure.

Attention-Deficit/Hyperactivity Disorder is not diagnosed if the symptoms are better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, Personality Disorder, Personality Change Due to a General Medical Condition, or a Substance-Related Disorder).  In all these disorders, the symptoms of inattention typically have an onset after the age of 7 years, and the childhood history of school adjustment generally is not characterized by disruptive behavior or teacher complaints concerning inattentive; hyperactive, or impulsive behavior. 

When a Mood Disorder or Anxiety Disorder co-occurs with Attention-Deficit/Hyperactivity Disorder, each should be diagnosed.
Attention-Deficit/Hyperactivity Disorder is not diagnosed if the symptoms of inattention, hyperactivity, or impulsivity related to the use of medication (e.g., bronchodilators, isoniazid, akathisia from neuroleptics) in children before age 7 years are not diagnosed as Attention-Deficit/Hyperactivity Disorder but instead are diagnosed as Other Substance-Related Disorder Not Otherwise Specified.

Differential Diagnosis Defined
from the American Psychiatric Association, 2000

In medicine, differential diagnosis (sometimes abbreviated DDx) is the systematic method physicians use to identify the disease causing a patient’s symptoms.
Before a medical condition can be treated, it must be identified.  Then, the physician lists the most likely causes.  The physician asks questions and performs tests to eliminate possibilities until he or she is satisfied that the single most likely cause has been identified.
Once a working diagnosis is reached, the physician prescribes a therapy.  If the patient’s condition does not improve, the diagnosis must be reassessed.
Each of these conditions can cause ADHD-like symptoms, such as inattention or difficulty concentrating, impulsivity or lack of self-control, motor restlessness or hyperactivity learning problems, or memory deficits.
Unfortunately these conditions are often mis-diagnosed as ADHD, which results in ADHD as a disorder being “over-diagnosed” in society. 
And, more importantly, the mis-diagnosed patient is then treated by his physician and/or therapist for ADHD. 
This means the wrong medications and the wrong treatment plans are used and that their condition is unlikely to improve.



Another Source of Information for ADHD
as published by the American Psychiatric Associaton, 2000

There are a number of conditions that resemble Attention-Deficit/Hyperactivity Disorder, but are not ADHD. 
Here are some of these conditions:

  • Bipolar Disorder (Early Onset Bipolar Disorder)
  • Tourette’s Syndrome
  • Childhood Depression
  • Oppositional Defiant Disorder
  • Pervasive Developmental Disorder PDD
  • Auditory Processing Disorder
  • Dyslexia
  • Autism or Aspergers
  • Schizophrenia or Other Psychotic Disorders
  • Anxiety Disorders
  • Child Abuse or Post Traumatic Stress Disorder
  • Fetal Alcohol Syndrome or Exposure to Drugs in utero
  • Thyroid Problems
  • Mild Mental Retardation
  • Drug Abuse
  • Mercury Poisoning, Heavy Metal Toxicity, Chemical Toxicity
  • Head Injuries or Brain Trauma
  • Food Allergies
  • Environmental Allergies

Understanding that these other conditions can mimic ADHD is part of making a good diagnosis. 
“Differential Diagnoses” must be considered before diagnosing ADHD.