So many conditions can look just like attention deficit hyperactivity disorder (ADHD) that it causes confusion in the diagnosis. Therefore, it is not surprising that so many people are misdiagnosed with ADHD!
Often, parents, teachers and doctors believe diagnosing ADHD in a child with a behavior problem is as simple as 1-2-3 or A-B-C. Unfortunately, this is not the case. Unlike medical problems such as diabetes mellitus, pneumonia, or a heart attack, there are no tests that can conclusively nail down the diagnosis. That’s right, there aren’t any blood tests, brain scans, genetic tests or even psychological tests that can tell a parent or a doctor that a child definitely has ADHD, or for that matter, doesn’t have ADHD.
In fact, ADHD is best diagnosed by first excluding more than 75 current medical, social, environmental, and psychological conditions that can mimic ADHD and cause mis-diagnosis of ADHD. Then, once those medical “zebras” have been ruled-out, the diagnosis of ADHD is made by observation and accurate reporting of behaviors that are consistent with ADHD as outlined by the American Psychiatric Association (APA) DSM-IV guidelines.
You can learn more about each of these ADHD zebras at MistakenforADHD. As you can see, the list is long and includes things most parents and teachers don’t think about as causing a child’s behavior problems, failing grades, or social problems. As many children will only show mild symptoms of ADHD we must keep watchful eyes, open minds and question whether learning-social-behavior problems could best be explained by something other than ADHD.
A few of the more than 75 things that can cause ADHD misdiagnosis include:
- Bipolar disorder
- Obstructive sleep apnea
- Diabetes Mellitus
- Pesticide poisoning
- Lead poisoning
- Teacher-student mismatch
- Generalized anxiety disorder
- Asperger Syndrome
- Sensory processing disorders
- Learning style differences
- Perceptual problems
- Hearing problems
The DSM-IV guidelines include observed behaviors of the core symptoms of ADHD-impulsivity, inattentiveness, and hyperactivity. Critical to this part of the diagnosis is the requirement that these behaviors:
- Must occur in more than one setting, such as home, school, work, church, social occasions or athletic events. A behavior only seen in one setting such as the classroom and nowhere else leaves the diagnosis seriously in doubt.
- Must cause the involved person a disability of some type - learning, getting along with others, participating, engaging in sports or social events.
- Must not be caused by or better explained by some other physical, medical, psychological, environmental or social condition.
- Some symptoms of ADHD (impulsivity, inattention, hyperactivity) should have been observed before age 7.
- Must include the key symptom of ADHD-inattentiveness, inability to focus or problems remaining on task.
Learn more about the American Psychological Association’s DSM-IV guidelines for diagnosing ADHD here.
As you can see, making the diagnosis of ADHD is not as simple as some would have us believe as evidenced by the fact that about ten percent of US children, ages 2 to 18 years, have been diagnosed as ADHD. You might be alarmed to discover that of those 15 million children and teens, about 25% to 40% or as many as 7 million have been wrongfully labeled with ADHD. Children misdiagnosed as ADHD often become victims of discrimination, bias and classroom bullying. Once labeled as ADHD, everyone just assumes they will fail or cause problems for the rest of their life.
We as parents, teachers, counselors, and healthcare professionals should slow down a little and avoid being so quick to slap the label of ADHD on behavior challenged children. As a result, about 7 million children won’t be exposed to unnecessary ADHD drugs and often serious side effects. And even more importantly, if inaccurately diagnosed and inappropriately treated, then the real reason for a child’s ADHD behavior will go undiagnosed and untreated subjecting them to failure in life.
What Can You Do To Prevent an ADHD Misdiagnosis?
If your child’s teacher is the one that brought the problem to your attention, don’t fall into the trap of assuming the teacher is absolutely correct. When discussing your child’s behavior or learning problem with their teacher, keep an open mind, ask a lot of questions and expect precise answers. Do not equate ADHD with replies like, “He acts up in class” or “he disrupts the class.” If a learning problem is suspected, gather as much information as you can about exactly what your child’s learning problem is and just as importantly, what it is not. Then have your child evaluated for the type of learning problem suspected. A Learning Disability (LD) is one of the medical zebras that can cause confusion about the diagnosis of ADHD.
Watch for signs of similar behavior problems in your child outside of the classroom- at home, church, athletic events, and other social occasions. By definition, ADHD is diagnosed by observing the disabling behavior or disability in more than one setting. Ask your child what he or she thinks is causing the teacher’s concern or is responsible for the behavior. Your child may be anxious, depressed or just going through a tough adjustment period or school/home transition and once treated, their behavior may return to what is normal for them.
Give your child’s ADHD doctor as much information as possible about his or her behavior problem and learning difficulties on their initial doctor’s visit. Failure to provide input from other family members, friends, teachers, and persons other than the parent is one of the most common reasons ADHD is so often misdiagnosed or under diagnosed.
Do not expect pills to always be the answer. Some kids with conditions that mimic ADHD may only need coaching or tutoring, while others might need treatment for childhood anxiety or depression or therapy for a medical problem such as hypothyroidism. Above all… you must be a very strong advocate for your child. Consider lifestyle changes as first line treatment for ADHD and don’t unnecessarily expose him or her to drugs, many amphetamines, with serious side effects that you wouldn’t take yourself.
To help with your child’s first doctor visit for evaluation of ADHD, I’ve prepared a checklist of questions that need to be answered. You can access the checklist at ADHDBehavior.com/ADHDquestions. These are very important, as the answers will set the overall tone for your child’s evaluation and successful treatment! In conclusion, it’s just as important that we not miss the diagnosis of ADHD in a child who is ADHD; as it is to prevent ADHD misdiagnosis in a child who is not. Both efforts will prevent your behavior or learning problem child from suffering inappropriate treatment and ending up labeled as a failure in life.
Read more about ADHD Misdiagnosis