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Misdiagnosis of Attention Deficit Hyperactivity Disorder

Misdiagnosis of Attention Deficit Hyperactivity Disorder

People are diverse, and so are their behaviors, emotions, and beliefs. This is one of the problems for diagnosis of ADHD in children and adolescents according to their hyperactive or inattentive behaviors. However, at what point in the range of behavior is a "hyperactive" child actually suffering from clinical hyperactivity. Similarly, some children who are "dreamy" or "shy" do not necessarily have clinical inattention syndromes. The use of Ritalin as a drug to medicate hyperactive children is a controversial issue, where many believe that a large number of actually normal children are being over-diagnosed with ADHD and given unnecessary medication....more about Attention Deficit Hyperactivity Disorder »

Alternative diagnoses list for Attention Deficit Hyperactivity Disorder:

For a diagnosis of Attention Deficit Hyperactivity Disorder, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Attention Deficit Hyperactivity Disorder:

Diseases for which Attention Deficit Hyperactivity Disorder may be an alternative diagnosis

The other diseases for which Attention Deficit Hyperactivity Disorder is listed as a possible alternative diagnosis in their lists include:

Attention Deficit Hyperactivity Disorder: Medical Mistakes

Related medical mistakes may include:

Attention Deficit Hyperactivity Disorder: Undiagnosed Conditions

Commonly undiagnosed conditions in related areas may include:

Discussion of diagnosis/misdiagnosis of Attention Deficit Hyperactivity Disorder:

Attention Deficit Hyperactivity Disorder (ADHD): NWHIC (Excerpt)

Behaviors can be judged as normal or "problem" by evaluating them in relation to the person's age and developmental maturity. For example, the same behaviors that are acceptable in a 5-year old may be problematic for a 10-year old. Problem behaviors are also long lasting, tend to occur more often and create more problems as time goes on. Children with ADHD will have more problems than other children their age experience in the same settings. (Source: excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC)

Attention Deficit Hyperactivity Disorder (ADHD): NWHIC (Excerpt)

Many girls and women with ADHD are often undiagnosed because their symptoms look different from those in boys or men. Many girls or women may not appear hyperactive. Girls are usually less rebellious, less defiant and generally considered less difficult than boys. Boys who are hyperactive and disorganized are easier to spot and more likely to be referred for an evaluation.

There are several personality types of girls in which ADHD could be a factor. For example, there are girls who are shy and withdrawn, but disorganized. There are girls who are "tomboys," who are drawn to risky activities. They may be cooperative at school and work hard to please parents and teachers, but are often disorganized and messy. There are "daydreamers" or girls who seem to listen to teachers in class, but be in another world. They may find their minds wandering, are forgetful and disorganized. They become very anxious, depressed, worried and overwhelmed when schoolwork is due. They often are thought to be less bright than they actually are. "Chatty" girls also have high activity levels, and are very talkative and emotional, but can be forgetful and disorganized. Highly intelligent girls, with above average IQs, who have increasing problems with concentration and organization as their school life becomes more demanding also may have ADHD.

Women with ADHD who complain of feeling overwhelmed and disorganized tend to be diagnosed more often with depression. These women often feel a powerful sense of shame and inadequacy. They oftentimes need to spend all of their waking energy just fighting their natural tendency to be disorganized. Sometimes, ADHD does not become a problem until a woman has a baby or a second baby, when she is expected to be highly organized, accomplishing multiple roles under a lot of strain as both a caregiver and, in many cases, a career woman. (Source: excerpt from Attention Deficit Hyperactivity Disorder (ADHD): NWHIC)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn't mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD? (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

The fact is, many things can produce these behaviors. Anything from chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive. For example, a formerly cooperative child who becomes overactive and easily distracted after a parent's death is dealing with an emotional problem, not ADHD. A chronic middle ear infection can also make a child seem distracted and uncooperative. So can living with family members who are physically abusive or addicted to drugs or alcohol. Can you imagine a child trying to focus on a math lesson when his or her safety and well-being are in danger each day? Such children are showing the effects of other problems, not ADHD.

In other children, ADHD-like behaviors may be their response to a defeating classroom situation. Perhaps the child has a learning disability and is not developmentally ready to learn to read and write at the time these are taught. Or maybe the work is too hard or too easy, leaving the child frustrated or bored. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

It's also important to realize that during certain stages of development, the majority of children that age tend to be inattentive, hyperactive, or impulsive--but do not have ADHD. Preschoolers have lots of energy and run everywhere they go, but this doesn't mean they are hyperactive. And many teenagers go through a phase when they are messy, disorganized, and reject authority. It doesn't mean they will have a lifelong problem controlling their impulses. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

What Can Look Like ADHD?

  • Underachievement at school due to a learning disability
  • Attention lapses caused by petit mal seizures
  • A middle ear infection that causes an intermittent hearing problem
  • Disruptive or unresponsive behavior due to anxiety or depression
(Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

For example, heavy alcohol use during pregnancy has been linked to fetal alcohol syndrome (FAS), a condition that can lead to low birth weight, intellectual impairment, and certain physical defects. Many children born with FAS show much the same hyperactivity, inattention, and impulsivity as children with ADHD. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

Whatever the specialist's expertise, his or her first task is to gather information that will rule out other possible reasons for the child's behavior. In ruling out other causes, the specialist checks the child's school and medical records. The specialist tries to sense whether the home and classroom environments are stressful or chaotic, and how the child's parents and teachers deal with the child. They may have a doctor look for such problems as emotional disorders, undetectable (petit mal) seizures, and poor vision or hearing. Most schools automatically screen for vision and hearing, so this information is often already on record. A doctor may also look for allergies or nutrition problems like chronic "caffeine highs" that might make the child seem overly active. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Attention Deficit Hyperactivity Disorder: NIMH (Excerpt)

Another debate is whether Ritalin and other stimulant drugs are prescribed unnecessarily for too many children. Remember that many things, including anxiety, depression, allergies, seizures, or problems with the home or school environment can make children seem overactive, impulsive, or inattentive. Critics argue that many children who do not have a true attention disorder are medicated as a way to control their disruptive behaviors. (Source: excerpt from Attention Deficit Hyperactivity Disorder: NIMH)

Common Misdiagnoses and Attention Deficit Hyperactivity Disorder

Mild worm infections undiagnosed in children: Human worm infestations, esp. threadworm, can be overlooked in some cases, because it may cause only mild or even absent symptoms. Although the most common symptoms are anal itch (or vaginal itch), which are obvious in severe cases, milder conditions may fail to be noticed in children. In particular, it may interfere with the child's good night's sleep. Threadworm is a condition to consider in children with symptoms such as bedwetting (enuresis), difficulty sleeping, irritability, or other sleeping symptoms. Visual inspection of the region can often see the threadworms, at night when they are active, but they can also be missed this way, and multiple inspections can be warranted if worms are suspected. See the introduction to threadworm.

Rare epilepsy misdiagnosed as ADHD: The less common disorder of temporal lobe epilepsy is a type of epilepsy without physical seizures. Some patients suffer from hyperactivity and similar symptoms, making a misdiagnosis of ADHD a possibility. See temporal lobe epilepsy and ADHD.

Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who had been institutionalized and treated for mental illness because he suffered from sudden inability to speak. This was initially misdiagnosed as a "nervous breakdown" and other mental conditions. He was later diagnosed as having had a stroke, and suffering from aphasia (inability to speak), a well-known complication of stroke (or other brain conditions).

Dementia may be a drug interaction: A common scenario in aged care is for a patient to show mental decline to dementia. Whereas this can, of course, occur due to various medical conditions, such as a stroke or Alzheimer's disease, it can also occur from a side effect or interaction between multiple drugs that the elderly patient may be taking. There are also various other possible causes of dementia.

Mesenteric adenitis misdiagnosed as appendicitis in children: Because appendicitis is one of the more feared conditions for a child with abdominal pain, it can be over-diagnosed (it can, of course, also fail to be diagnosed with fatal effect). One of the most common misdiagnosed is for children with mesenteric adenitis to be misdiagnosed as appendicitis. Fortunately, thus misdiagnosis is usually less serious than the reverse failure to diagnose appendicitis.

Blood pressure cuffs misdiagnose hypertension in children: One known misdiagnosis issue with hyperension, arises in relation to the simple equipment used to test blood pressure. The "cuff" around the arm to measure blood pressure can simply be too small to accurately test a child's blood pressure. This can lead to an incorrect diagnosis of a child with hypertension. The problem even has a name unofficially: "small cuff syndrome". See misdiagnosis of hypertension.

Mild traumatic brain injury often remains undiagnosed: Although the symptoms of severe brain injury are hard to miss, it is less clear for milder injuries, or even those causing a mild concussion diagnosis. The condition goes by the name of "mild traumatic brain injury" (MTBI). MTBI symptoms can be mild, and can continue for days or weeks after the injury. See the symptoms of MTBI or misdiagnosis of MTBI.

ADHD under-diagnosed in adults: Although the over-diagnoses of ADHD in children is a well-known controversy, the reverse side related to adults. Some adults can remain undiagnosed, and indeed the condition has usually been overlooked throughout childhood. There are as many as 8 million adults with ADHD in the USA (about 1 in 25 adults in the USA). See misdiagnosis of ADHD or symptoms of ADHD.

MTBI misdiagnosed as balance problem: When a person has symptoms such as vertigo or dizziness, a diagnosis of brain injury may go overlooked. This is particularly true of mild traumatic brain injury (MTBI), for which the symptoms are typically mild. The symptoms has also relate to a relatively mild brain injury (e.g. fall), that could have occurred days or even weeks ago. Vestibular dysfunction, causing vertigo-like symptoms, is a common complication of mild brain injury. See causes of dizziness, causes of vertigo, or misdiagnosis of MTBI.

Bipolar disorder misdiagosed as various conditions by primary physicians: Bipolar disorder (manic-depressive disorder) often fails to be diagnosed correctly by primary care physicians. Many patients with bipolar seek help from their physician, rather than a psychiatrist or psychologist. See misdiagnosis of bipolar disorder.

Eating disorders under-diagnosed in men: The typical patient with an eating disorder is female. The result is that men with eating disorders often fail to be diagnosed or have a delayed diagnosis. See misdiagnosis of eating disorders or symptoms of eating disorders.

Depression undiagnosed in teenagers: Serious bouts of depression can be undiagnosed in teenagers. The "normal" moodiness of teenagers can cause severe medical depression to be overlooked. See misdiagnosis of depression or symptoms of depression.

Brain pressure condition often misdiagnosed as dementia: A condition that results from an excessive pressure of CSF within the brain is often misdiagnosed. It may be misdiagnosed as Parkinson's disease or dementia (such as Alzheimer's disease). The condition is called "Normal Pressure Hydrocephalus" (NPH) and is caused by having too much CSF, i.e. too much "fluid on the brain". One study suggested that 1 in 20 diagnoses of dementia or Parkinson's disease were actually NPH. See misdiagnosis of Alzheimer's disease or misdiagnosis of Parkinson's disease.

Post-concussive brain injury often misdiagnosed: A study found that soldiers who had suffered a concussive injury in battle often were misdiagnosed on their return. A variety of symptoms can occur in post-concussion syndrome and these were not being correctly attributed to their concussion injury. See introduction to concussion.

Children with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in pediatric patients. These patients are not the typical migraine sufferers, but migraines can also occur in children. See misdiagnosis of migraine or introduction to migraine.

Undiagnosed anxiety disorders related to depression: Patients with depression (see symptoms of depression) may also have undiagnosed anxiety disorders (see symptoms of anxiety disorders). Failure to diagnose these anxiety disorders may worsen the depression. See misdiagnosis of depression or misdiagnosis of anxiety disorders.

Vitamin B12 deficiency under-diagnosed: The condition of Vitamin B12 deficiency is a possible misdiagnosis of various conditions, such as multiple sclerosis (see symptoms of multiple sclerosis). See symptoms of Vitamin B12 deficiency or misdiagnosis of multiple sclerosis.

Attention Deficit Hyperactivity Disorder: Rare Types

Rare types of medical disorders and diseases in related medical areas:

Medical news summaries about misdiagnosis of Attention Deficit Hyperactivity Disorder:

The following medical news items are relevant to misdiagnosis of Attention Deficit Hyperactivity Disorder:

General Misdiagnosis Articles

Read these general articles with an overview of misdiagnosis issues.

About misdiagnosis:

When checking for a misdiagnosis of Attention Deficit Hyperactivity Disorder or confirming a diagnosis of Attention Deficit Hyperactivity Disorder, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. These alternate diagnoses of Attention Deficit Hyperactivity Disorder may already have been considered by your doctor or may need to be considered as possible alternative diagnoses or candidates for misdiagnosis of Attention Deficit Hyperactivity Disorder. For a general overview of misdiagnosis issues for all diseases, see Overview of Misdiagnosis.

 

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