How to differentiate ADHD from other possible disorders?

Let's see what are the characteristics of adhd and what other disorders it can be confused with.

You may have seen or heard the acronym ADHD, but... Do you know what Attention Deficit Hyperactivity Disorder is and how to distinguish it from other disorders?

ADHD is a neurobiological disorder that usually originates in childhood and can also be present in adolescence or adulthood.

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is classified as a Neurodevelopmental Disorder. Its nuclear symptoms are: attention deficit, hyperactivity and/or impulsivity.

What does ADHD look like?

Generally, people with ADHD may have the following characteristics at the cognitive or behavioral level: difficulty in concentration and perseverance, problems in planning or organizing tasks, complications in implementing self-control (inhibiting thoughts or actions), deficits in working memory, difficulty in identifying/recognizing emotions, or problems with social interaction. (inhibiting thoughts or actions), deficits in working memory, difficulty identifying/recognizing emotions or problems with social interaction.

Different variables must be taken into account when diagnosing a child with ADHD, because we quickly tend to put the label when we see a child who is restless or inattentive, but we must remember that it is a chronic disorder, which consists of a structural, functional and connectivity alteration between different brain areas.

Thus, a detailed clinical history is required.integrating various sources of information and taking into account the diagnostic criteria of the current DSM (DSM-5). Thus, the diagnosis requires the persistence of symptoms of inattention and/or hyperactivity/impulsivity with an intensity that significantly interferes with the child's functioning in at least two different contexts.

In relation to the above, each case must be evaluated on an individual basis, exploring, in addition, the presence of comorbidity with other disorders and possible differential diagnosis, since the core symptoms may be related to other disorders.The core symptoms may be present in other pathologies. In this sense, these symptoms may be secondary to other disorders, comorbid or both situations at the same time. Let's see it in more detail, below.

Differential diagnosis

In relation to the above, each case must be evaluated individually, exploring, in addition, the presence of comorbidity with other disorders and possible differential diagnosis, since the nuclear symptoms may be present in other pathologies.

In this sense, such symptoms may be secondary to other disorders, comorbid or both situations at the same time.. Let's see it in more detail, below.

ADHD symptoms secondary to environmental factors:

• Stressful environmental situations or contexts.
• Inconsistent caregivers.
• Situations of child neglect and/or abuse and/or maltreatment.
• Poor sleep hygiene.
• Malnutrition.

ADHD symptoms secondary to other illnesses:

• Significant sensory deficits.
• Adverse effect of drugs (bronchodilators, antiepileptics).
• Alterations in thyroid function, both in the hypo and hyper sense.
• Lead intoxication.
• Infectious processes such as encephalitis or meningitis.
• Iron deficiency anemia.
• Some types of neoplasms.

With what pathologies does ADHD have comorbidity?

Approximately half of the patients diagnosed with ADHD have at least one comorbid disorder.. Therefore, possible comorbidities must be taken into account when making the diagnosis, since the presence of other disorders (added to the ADHD diagnosis) can influence the initial clinical presentation, the evolution of the symptomatology and the response to intervention.

Comorbidity with neurodevelopmental disorders

With a diagnosis of ADHD, the presence of other neurodevelopmental disorders should be explored and vice versa.

Intellectual developmental disorders

The occurrence of ADHD symptoms in persons with intellectual disabilities is estimated to be higher than the rates obtained in the general population..

Communication disorders.

Different studies describe a strong comorbidity between social or pragmatic communication disorder and other disorders, such as ADHD.

3. Autism Spectrum Disorders (ASD)

The most recent edition of the DSM (DSM-5) allows a person to be diagnosed with both ASD and ADHD, when previously it was not possible.. Both share some symptoms and appear to share the same impairment; they have impairments in executive function, although with different nuances.

For example, children with ADHD experience deficits in inhibitory control while children with ASD have severe problems in cognitive flexibility and planning, usually retaining inhibitory skills.

4. Specific learning disorders

Its comorbidity with ADHD is around 20%.. Academic difficulties as a consequence of problems in the integration of knowledge is one of the characteristics most clearly associated with ADHD.

However, ADHD and learning disorders are distinct entities that can occur simultaneously and can be distinguished from each other. For example, children with ADHD tend to be more variable in their performance, as performance is often dependent on environmental conditions.

5. Motor disorders

More than 30% of patients with a diagnosis of ADHD usually present very rigid movements or alterations in motor coordination.. It is significant the number of children with ADHD who have frequent falls or stumbles as a result of their gross motor deficiencies.

Comorbidity with other disorders

These are other health disorders that often overlap with the symptomatology of ADHD.

1. Disruptive Behavior Disorders

They have a 40% comorbidity with ADHD.. The types of disorders that we find are those of a negativistic, defiant or aggressive nature.

2. Anxiety disorders

With 25% comorbidity, anxiety disorders also overlap a lot with ADHD.. The most common symptoms are excessive concern about competence in certain areas, unrealistic fear of future events or an excessive need for reassurance.

3. Mood disorders

Comorbidity is 30%.. Major depressive disorder is more prevalent among children with ADHD than in the general population. Feelings of worthlessness, inadequacy or low self-esteem appear, as well as a depressed mood or sleep and eating disturbances.

4. Substance abuse disorders

One of the most frequently occurring comorbid disorders in adults diagnosed with ADHD is substance abuse disorder. Approximately 20-30% of patients with substance abuse disorder present with ADHD..

When ADHD symptoms may be secondary or comorbid

In the following pathologies, ADHD symptomatology may occur secondarily, or it may also present comorbidly. This can increase the difficulty of diagnosisSometimes, a double diagnosis is required for a correct treatment of both problems.

• Cranioencephalic trauma.
• Acquired brain damage.
• Epilepsy.
• Sleep disorders.
• Fetal alcohol syndrome.
• Genetic syndromes: Fragile X, Prader-Willi, Klinefelter, etc.

In conclusion...

In short, ADHD goes beyond a child who misbehaves, does not listen or is very nervous, or a person who does not pay attention or has difficulties in planning and organization..

As I said, to carry out a proper diagnosis, it is necessary to elaborate a clinical history in a meticulous way, taking into account different sources of information, assessing the nature of the symptomatology presented to us, as well as the degree of impact on the different contexts of the individual we are evaluating.

Thus, in line with the above, we cannot leave aside the differential diagnosis and the exploration of other possible disorders or comorbid diseases.

Author: Maribel Martín, General Health Psychologist at Centro Rapport Psicología.