Children are readily diagnosed
with ADHD due to sleeping troubles, careless mistakes, fidgeting, or
forgetfulness. The Centers for Disease Control and Prevention cite ADHD as the most commonly diagnosed
behavioral disorder in children under 18.
However, many medical conditions
in children can mirror ADHD symptoms, which makes correct diagnosis difficult.
Rather than jump to conclusions, it’s important to consider alternative
explanations to ensure accurate treatment.
Disorder and ADHD
The most difficult differential
diagnosis to make is between ADHD and bipolar mood disorder. These two
conditions are often hard to distinguish because they share several symptoms,
ADHD is characterized primarily
by inattention, distractibility, impulsivity, or physical restlessness. Bipolar
disorder causes exaggerated shifts in mood, energy, thinking, and behavior, from
manic highs to extreme, depressive lows. While bipolar disorder is primarily a
mood disorder, ADHD affects attention and behavior.
There are many distinct
differences between ADHD and bipolar disorder, but they are subtle and may go
unnoticed. ADHD is a lifelong condition, beginning before age 7, while bipolar
disorder tends to develop later, after age 18.
ADHD is chronic, while bipolar
disorder is usually episodic, and can remain hidden for periods between
outbursts. ADHD children tend to be unnerved by sensory overstimulation, like
transitions from one activity to the next, while bipolar children typically
respond to disciplinary actions and conflict with authority figures.
Depression, irritability, and memory loss are common after a bipolar tantrum,
but children with ADHD do not generally experience despair as a symptom.
The moods of someone with ADHD
approach suddenly and can dissipate quickly, often within 20 to 30 minutes. But
the mood shifts of bipolar disorder can last for hours or days. Bipolar
children seem to display ADHD symptoms during their “manic” phases, such as
restlessness, trouble sleeping, and hyperactivity.
During their “depressed” phases,
symptoms such as lack of focus, lethargy, and inattention, can also mirror
those of ADHD. However, bipolar children may experience severe nightmares,
difficulty waking in the morning, waking up multiple times throughout the
night, and fear of going to sleep. Children with ADHD tend to wake up quickly
and become alert immediately. They may have trouble falling asleep, but can
usually manage to sleep through the night without interruption.
The misbehavior of children with
ADHD is usually accidental. Ignoring authority figures, running into things,
and making messes is the result of inattentiveness. A bipolar child, however,
challenges authority through arguing, physical contact, or intentional
Bipolar children are sensitive to
ways of creating the biggest impact or contention, and do all they can to make
a scene. Bipolar children often seek danger, grandiosity, and argument in an
attempt to generate conflict.
From our community
Only a mental health professional
can accurately differentiate between ADHD and bipolar disorder. If your child
is diagnosed with bipolar disorder, primary treatment includes psycho-stimulant
and antidepressant medications, individual or group therapy, and tailored
education and support. Medications may need to be combined or frequently
changed to continue to produce beneficial results.
Children with autism spectrum
disorders are often overexcited by stimulating environments and may struggle
with social interactions. The behavior of autistic children may mimic the
hyperactivity and social development issues common in ADHD patients. Mental
handicaps can also manifest as the emotional immaturity associated with ADHD.
Social skills and the ability to learn are inhibited in children with both
conditions, which causes issues in school and at home.
Blood Sugar Levels
Something as innocent as low
blood sugar (hypoglycemia) can also mimic the symptoms of ADHD. Hypoglycemia in
children may cause aggression, hyperactivity, the inability to sit still, and
the inability to concentrate.
Sensory processing disorders (SPD)
can produce symptoms similar to ADHD. These disorders are marked by under- or
- body position
Children with SPD may be sensitive
to a certain fabric, may fluctuate from one activity to the next, and may be
accident-prone or have difficulty paying attention, especially if they feel
Children with ADHD tend to have
difficulty calming down and falling asleep. However, some children who suffer
from sleep disorders may display symptoms of ADHD during waking hours without
actually having the disorder.
Lack of sleep causes difficulty
concentrating, communicating, and following directions, and creates a decrease
in short-term memory.
It may be difficult to diagnose
hearing problems in young children who don’t know how to fully express
themselves. Children with hearing impairments have a hard time paying attention
because of their inability to hear properly.
Missing details of conversations
may appear to be caused by the child’s lack of focus, when in fact they simply
cannot follow along. Children with hearing problems may also have difficulty in
social situations and have underdeveloped communication techniques.
Some children diagnosed with ADHD
don’t suffer from any medical condition, but are simply normal, easily
excitable, or bored. According to research published in the Canadian Medical Association Journal, the age of a child relative to their peers
has been shown to influence a teacher’s perception of whether or not they have
Children who are young for their
grade levels may receive an inaccurate diagnosis because teachers mistake their
normal immaturity for ADHD. Children who, in fact, have higher levels of
intelligence than their peers may also be misdiagnosed because they grow bored
in classes that they feel are too easy.