Children are readily diagnosed with attention deficit hyperactivity disorder (ADHD) due to sleeping troubles, careless mistakes, fidgeting, or forgetfulness.

The Centers for Disease Control and Prevention (CDC) cites ADHD as the most commonly diagnosed neurobehavioral condition in children under 18.

However, many medical conditions in children can mirror ADHD symptoms, which can make getting a correct diagnosis difficult.

Rather than jump to conclusions, it’s important to consider alternative explanations to ensure an accurate diagnosis and treatment.

The most difficult differential diagnosis for doctors to make is between ADHD and bipolar disorder. These two conditions are often hard to distinguish because they share several symptoms, including:

  • mood changes
  • outbursts
  • restlessness
  • talkativeness
  • impatience

ADHD is characterized primarily by:

  • inattention
  • distractibility
  • impulsivity
  • physical restlessness

Bipolar disorder causes more severe shifts in:

  • mood
  • energy
  • thinking
  • behavior

While bipolar disorder is primarily a mood disorder, ADHD affects attention and behavior.

Differences

There are many distinct differences between ADHD and bipolar disorder, but they’re subtle and may go unnoticed. ADHD is generally first noticed in children, while bipolar disorder tends to develop in late adolescence or early adulthood (although some cases may be diagnosed earlier).

ADHD symptoms occur continuously, while bipolar disorder symptoms are usually episodic. Bipolar disorder symptoms may not occur during periods between episodes of mania or depression.

Children with ADHD may experience difficulty with sensory overstimulation, like transitions from one activity to the next. Children with bipolar disorder typically respond to disciplinary actions and conflict with authority figures.

Depression, irritability, and memory loss are common after a symptomatic period for people with bipolar disorder, and can even be found in people with ADHD. However, these symptoms are often secondary to symptoms related to attention and concentration.

Moods

The moods of someone with ADHD approach suddenly and can dissipate quickly, often within 20 to 30 minutes. The mood shifts seen in bipolar disorder last longer.

To confirm a diagnosis of bipolar disorder, a major depressive episode must last for 2 weeks, while a manic episode must last at least 1 week with symptoms present for most of the day, nearly every day. The duration may be less if symptoms become so severe that hospitalization becomes necessary.

Hypomanic episodes, or less severe manic episodes, generally last a few days.

People with bipolar disorder appear to display ADHD symptoms during manic episodes, such as restlessness, trouble sleeping, and hyperactivity.

During depressive episodes, symptoms such as lack of focus, lethargy, and inattention can also mirror those of ADHD. However, people with bipolar disorder may experience difficulty falling asleep or may sleep too much. People with ADHD can have similar sleep issues due to hyperactivity and restlessness, but they’re more common with bipolar disorder.

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.

Behavior

The misbehavior of children with ADHD and children with bipolar disorder is usually accidental. Ignoring authority figures, running into things, and making messes is often the result of inattentiveness, but it may also be a result of a manic episode.

Children with bipolar disorder may engage in impulsive behavior. They may demonstrate grandiose thinking and take up projects that they clearly cannot complete at their age and developmental level.

Only a mental health professional can accurately differentiate between ADHD and bipolar disorder.

If your child receives a bipolar disorder diagnosis, primary treatment often includes:

  • psychostimulant and antidepressant medications
  • individual or group therapy
  • tailored education and support

It’s normal for treatments to be combined or frequently changed so they continue to produce beneficial results.

Children with autism spectrum disorder often appear detached from their environments and may struggle with social interactions. In some cases, the behavior of autistic children may mimic the hyperactivity and social development issues common in children with ADHD.

Other behaviors may include emotional immaturity, which may also be seen with ADHD.

Social skills and the ability to learn may be inhibited in children with both conditions, which can cause issues in school and at home.

Something as simple as low blood sugar (hypoglycemia) can also mimic the symptoms of ADHD.

Hypoglycemia in children may cause:

  • uncharacteristic aggression
  • hyperactivity
  • inability to sit still
  • inability to concentrate

Sensory processing disorder (SPD) can produce symptoms similar to ADHD. SPD is marked by under- or oversensitivity to:

  • touch
  • movement
  • body position
  • sound
  • taste
  • sight
  • smell

For example, children with SPD may be sensitive to a certain fabric. They may fluctuate from one activity to the next, and they may be prone to accidents or have difficulty paying attention, especially if they feel overwhelmed.

Children with ADHD may have difficulty calming down and falling asleep. However, some children with sleep disorders may display symptoms of ADHD during waking hours without actually having the condition.

Lack of sleep causes difficulty concentrating, communicating, and following directions. It also creates a decrease in short-term memory.

It may be difficult to diagnose hearing problems in young children who don’t know how to fully express themselves. Children with hearing problems 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 they simply can’t follow along.

Children with hearing problems may also have difficulty in social situations and have underdeveloped communication techniques.

Some children with an ADHD diagnosis are actually misdiagnosed and don’t have ADHD or any other health condition. They’re simply being themselves, such as easily excitable or bored.

According to a 2012 study, the age of a child relative to their peers has been shown to influence a teacher’s perception of whether they have ADHD.

Researchers found that children who are young for their grade level may be misdiagnosed with ADHD because teachers mistake their normal immaturity for ADHD.

Children who, in fact, have higher levels of intelligence than their peers may also get misdiagnosed with ADHD because they grow bored in classes that they feel are too easy.

ADHD is a common condition in both children and adults.

However, if you feel like an ADHD diagnosis might not be correct, continue seeking help. It’s possible that you or your child have a different condition altogether.