Impulsive & Hyperactive? It Doesn’t Mean You Have ADHD

Many other conditions have similar symptoms, experts say, so avoid the pull of self-diagnosis.

The 6-year-old boy sitting across from Douglas Tynan, a child and adolescent clinical psychologist based in Delaware, clearly did not have attention deficit hyperactivity disorder. Dr Tynan was sure of that. But the boy’s first-grade teacher disagreed.

He could be inattentive in class, but at home his behaviour wasn’t out of the ordinary for a child his age. A voracious reader, he told Dr Tynan that he liked to bring his own books to school because the ones in class were too easy.

What his teacher had not considered was that the child was most likely academically gifted, as his mother had been as a child, Dr Tynan said. (Studies have shown that Black children, like the boy in his office, are less likely to be identified for gifted programmes.)

Further testing revealed that Dr Tynan was correct. The child wasn’t inattentive in school because of ADHD. It was because he was bored.

ADHD is a neurodevelopmental disorder that begins in childhood and typically involves inattention, disorganisation, hyperactivity and impulsivity that cause trouble in two or more settings, like at home and at school.

But those symptoms — for children and adults alike — can overlap with a multitude of other traits and disorders. In fact, difficulty concentrating is one of the most common symptoms listed in the American Psychiatric Association’s diagnostic manual, and it’s associated with 17 diagnoses, according to a study published in April.

Patients need a careful evaluation to avoid either being misdiagnosed with ADHD or having a missed ADHD diagnosis. Here’s a look at some common problems that can mimic ADHD.

Behaviour and mood disorders

Those symptoms might include a lack of focus or motivation, acting out emotionally, or difficulty planning and following through on tasks, said Max Wiznitzer, a pediatric neurologist at Rainbow Babies and Children’s Hospital in Cleveland and an ADHD expert.

That is true for both adults and children. Among Dr Wiznitzer’s patients, it is anxiety that is most often mistaken for ADHD.

“Can a person with anxiety focus?” he said. “Well, no. The reason for the poor focus is not the same thing as ADHD, but the end result is the same.”

And to make things even more complex, it’s common for those with ADHD to have a behavioural or mood disorder as well.

Substance use

Heavy substance use can result in a lack of focus as well as hyperactivity, among other issues. If someone has been using drugs for years and then complains to a doctor about a decline in cognitive ability — such as difficulty paying attention, retaining information or remembering things — it is crucial to look at how long the person has had those symptoms, said Dr David W. Goodman, an assistant professor of psychiatry and behavioural sciences at the Johns Hopkins University School of Medicine.

If the symptoms were not present before age 12, then the patient wouldn’t meet the diagnostic criteria for ADHD, he added.

A 2017 study found that about 95% of participants who first demonstrated ADHD-like symptoms at 12 or older did not have the disorder, despite screening positive on symptom checklists. Of those who had impairing symptoms, the most common reason was actually heavy substance use, followed by disorders like depression and anxiety.

Sleep problems

Studies have indicated that sleep deprivation hurts a person’s ability to think clearly and perform certain tasks and can also negatively affect mood.

One large study found that people who typically slept between three and six hours performed worse on cognitive tests that measured the brain’s ability to hold information and the length of time it took to finish a task. These impairments mimic common ADHD symptoms like mental sluggishness, forgetfulness or the habit of leaving tasks unfinished.

Digital distraction

Anyone who owns a smartphone is continually inundated with texts, notifications and opportunities to scroll — it can feel as though our attention is constantly being diverted or that our capacity to focus has shortened. But that does not mean we all have ADHD.

Take away the screens, and a neurotypical person can focus better, whereas someone with ADHD will still have trouble focusing even when any external distractions have been removed, Dr. Goodman said.

People who consider themselves heavy users of digital technology are more likely to report ADHD symptoms, research suggests, but not all heavy users have the disorder.

Physical conditions and stress

Therapists and researchers who focus on the disorder say it is important to get a medical evaluation before an ADHD diagnosis because there is such a wide variety of illnesses that can create ADHD-like symptoms, such as inattention, memory problems or brain fog, which can make people feel sluggish, easily distracted and forgetful.

Some examples include brain injury, chronic conditions like fibromyalgia or POTS, diabetes, heart problems or endocrine disorders like hypothyroidism.

Stress — both chronic and acute — can also mimic ADHD, leading to difficulty with planning, organisation and self-regulation.

So how do you know if it’s actually ADHD?

A proper ADHD diagnosis requires several steps: An interview with the patient, a medical and developmental history, symptom questionnaires and, if possible, conversations with other people in the patient’s life, like a spouse or teacher.

Questionnaires alone are not enough. One study found that when adults filled out an ADHD scale, they were often identified as having ADHD — even when they did not.

It can be trickier to diagnose ADHD in adults because they have a longer life history, which means a greater number of complicating factors, said Margaret Sibley, a professor of psychiatry and behavioural sciences at the University of Washington School of Medicine in Seattle. In addition, there are no US clinical practice guidelines for diagnosing and treating patients beyond childhood.

That has led some patients to flock online for a speedy diagnosis and a prescription. Others attempt to untangle their symptoms by researching the disorder on social media.

“There’s this movement toward self-diagnosis and questioning whether a medical diagnosis is necessary,” Dr Sibley said. “But you have to be careful, because if you misdiagnose yourself, you may miss out on the correct solution to your problems,” she added.

In the end, getting a comprehensive evaluation is the best route. Dr Sibley suggested starting with a primary care provider and then seeking out a mental health professional.

Dr. Tynan said he typically assumes a patient does not have ADHD and then tries to look at everything else that might be causing the symptoms. “If I see strong evidence of anxiety, depression and ADHD, I have to ask, What is going on here?” he said.

Written by: Christina Caron

Illustration by: Vartika Sharma

©2024 THE NEW YORK TIMES

More on health and wellbeing

What impacts your body and how.

The three stages of stress (and how to manage it). Is there such a thing as good stress?

How to manage your blood sugar levels. Our blood glucose levels can have a big impact on how we feel each day.

What happens when you don’t have enough ‘beauty sleep’? And how can you encourage a good night’s sleep?

Brittle nails or thinning hair? Now’s the time to listen to your body. You don’t want to ignore what might be going on internally.

Dr Libby: These everyday habits could be sabotaging your sleep. Want to get a better night’s sleep? Remove these silent saboteurs.