The Centers for Disease Control and Prevention cite ADHD as the most commonly diagnosed behavioral disorder in children under 18 (CDC, 2012). Children are readily diagnosed with ADHD due to sleeping troubles, careless mistakes, fidgeting, or forgetfulness. However, many medical conditions in children can mirror ADHD symptoms, which makes correct diagnosis difficult. Rather than jump to conclusions, it is important to consider alternative explanations to ensure accurate treatment.
Bipolar 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, including:
- mood instability
ADHD is characterized primarily by inattention, distractibility, impulsivity, and/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 dormant for periods between outbursts. ADHD children tend to be unnerved by sensory overstimulation, such as 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 untriggered 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 aggression. 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.
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.
Low Blood Sugar Levels
Something as benign as low blood sugar 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
Sensory processing disorders (SPD) can produce symptoms similar to ADHD. These disorders are marked by under- or over-sensitivity to touch, movement, body position, sound, taste, sight, or smell. Children with SPD may be inexplicably averse 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 overwhelmed.
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 do not 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 he or she simply cannot follow along. Children with hearing problems may also have difficulty in social situations and have underdeveloped communication techniques.
Kids Being Kids
Some children diagnosed with ADHD do not suffer from any medical condition, but are simply normal, easily excitable, or bored. The age of a child relative to their peers has been shown to influence a teacher’s perception of whether or not he or she has ADHD (Morrow, 2012). 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.