5 conditions not to mistake for ADHD

“Where should I go to have my son evaluated for ADHD?” seems to be a straightforward question, but it is not.

This parent believes, rightly or wrongly, that ADHD may be the reason behind the child’s behaviour. Given the range of problems that could explain a lack of concentration, behavior difficulties or problems at school, the likelihood that the problems could be caused by something else should always be considered fully.

Importantly, raising this possibility does not call into question the difficulties the child may be experiencing, but it supports patients, parents and clinicians to reach the right diagnosis — whether ADHD or another condition — and pursue the most effective treatment. This article highlights 5 common conditions in children that resemble ADHD, stressing the importance for a comprehensive evaluation.

1. Sleep problems

Approximately 25 percent of all children experience a sleep problem at some point during childhood, ranging from short-term difficulties in falling asleep and night waking, to more serious sleep disorders, such as obstructive sleep apnea [1]. Whilst trouble paying attention, forgetfulness and poor impulse control can be a direct result of poor sleep, they are also defining features of ADHD. Furthermore, the presence of ADHD can cause sleep problems, complicating matters for parents or teachers observing these behaviors in a child.

2. Vision problems

According to Prevent Blindness America, one in four of school-age children have vision problems that, if left untreated, can have an impact on a child’s learning ability, personality and adjustment in school. Yet, untreated vision problems in children also elicit similar signs to ADHD, which can cause delay in pinpointing the root cause of a child’s problems. A child with a vision problem can present with difficulties paying close attention to details, avoid tasks that require extended periods of mental effort and not follow instructions, all showing a resemblance to ADHD.

3. Hearing loss

Approximately 15 percent of children in the United States have hearing loss [2]. Although most of these children will have received a hearing screening as an infant, hearing loss can occur at any time, and it may not be evident immediately. Acquired hearing loss, for example, can arise from various causes, including head injuries, ear infections and exposure to very loud noises. The loss of hearing, or in fact any issue with hearing, can result in a child failing to pick up cues or responding inappropriately to sounds and voices, if at all. From a parent or teacher’s point of view, it could look as though the child is daydreaming, not following directions or unable to pay attention.

4. Traumatic Brain Injury

In the United States, approximately half a million children ages 0–14 years are admitted to emergency rooms each year because of a Traumatic Brain Injury (TBI) [3]. According to the Brain Injury Association of America a TBI is “a blow, jolt, or bump to the head that disrupts the normal function of the brain” and symptoms can be wide-ranging. From physical to cognitive, emotional and behavioural problems, including forgetfulness, poor focus, memory problems, impulsiveness, emotional outbursts and aggression. Considering that the problems related to a TBI and ADHD look so similar, they can be hard to tell apart for parents and teachers and the impact of a past TBI should not be overlooked.

5. Thyroid problems

In young children, thyroid hormones are critical for brain development and thyroid problems affect all aspects of a child’s health including growth and development. The American Association of Clinical Endocrinologists (AACE) estimates that approximately 13 million people have undiagnosed thyroid problems [4] and 4.6% of the population are found to have hypothyroidism [5], when the thyroid gland is underactive and does not produce enough thyroid hormones. Hypothyroidism is the most common thyroid disorder affecting children and symptoms can resemble those of ADHD, including problems regarding memory, attention and learning.

What’s next?

This article is by no means exhaustive as there are several other medical, biological, emotional and mental conditions that can resemble ADHD. It does, however, give an indication how symptom overlap between ADHD and other problems can make it difficult to determine whether one – or in some cases both – of these conditions are present. The key for the parent searching for the reason behind their child’s behavior, therefore, is a thorough, high-quality ADHD evaluation, to ensure that the child receives the right diagnosis, and the best treatment. All children, whatever their condition, deserve no less.

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1. Owens, J. (2008). Classification and Epidemiology of Childhood Sleep Disorders. Primary Care: Clinics in Office Practice, 35(3), 533-546.
2. Niskar, A. S., Kieszak, S. M., Holmes, A., Esteban, E., Rubin, C., & Brody, D. J. (1998). Prevalence of hearing loss among children 6 to 19 years of age: The Third National Health and Nutrition Examination Survey. Journal of the American Medical Association, 279(14), 1071–1075.
3. Faul, M., Xu, L., Wald, M. M., & Coronado, V. G. (2010). Traumatic brain injury in the United States: Emergency department visits, hospitalizations and deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
4. Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I. … Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18, 988–1028.
5. Hollowell, J. G., Staehling, N. W., Flanders, W.D., Hannon, W.H., Gunter, E. W., Spencer, C. A. & Braverman, L. E. (2002). Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). The Journal of Clinical Endocrinology and Metabolism, 87, 489–499.