How to differentiate ADHD from other possible disorders?

You may have ever seen or heard the acronym ADHD, but... Do you know what Attention Deficit Hyperactivity Disorder consists of 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 adult life.

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

• Related article: "Types of ADHD (characteristics, causes and symptoms)"

What is ADHD like?

Generally, people with ADHD can have the following cognitive or behavioral characteristics: Difficulty concentrating and perseverance, problems planning or organizing tasks, difficulties in starting their self-control (inhibit thoughts or actions), deficit in working memory, difficulty in identifying / recognizing emotions or problems with social interaction.

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

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

In relation to the above, each case must be evaluated individually, also exploring the presence of comorbidity with other disorders and possible differential diagnosis, since the nuclear symptoms may be present in other pathologies. In this sense, these symptoms may be secondary to other disorders, comorbid, or both at the same time. We will see it in more detail below.

• You may be interested in: "The 7 types of neurodevelopmental disorders (symptoms and causes)"

Differential diagnosis

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

In this sense, These symptoms may be secondary to other disorders, comorbid, or both at the same time.. We will see it in more detail below.

ADHD symptoms secondary to environmental factors:

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

ADHD symptoms secondary to other diseases:

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

• Related article: "The 16 most common mental disorders"

With what pathologies does ADHD have comorbidity?

About half of patients diagnosed with ADHD have at least one comorbid disorder. Therefore, it is necessary to take into account, at the time of diagnosis, the possible comorbidities, since the presence of other disorders (added diagnosis of ADHD) can influence the initial clinical presentation, the evolution of the symptoms and the response to the intervention.

Comorbidity with neurodevelopmental disorders

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

1. Intellectual development disorders

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

• You may be interested in: "Intellectual and developmental disability"

2. Communication disorders

Different studies describe a strong comorbidity between social or pragmatic communication disorder with 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 disorders, ASD and ADHD, when it was not possible before. Both share some symptoms and seem to share the same deterioration; they present alterations in executive function, although with different nuances.

For example, children with ADHD experience deficits in inhibitory control while children with ASD have severe problems with cognitive flexibility and planning, generally preserving inhibition.

• You may be interested in: "The 4 types of autism and their characteristics"

4. Specific learning disorders

Their 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 different entities that can occur simultaneously, distinguishing each other. For example, children with ADHD tend to be more variable in their performance, since this often depends on environmental conditions.

• Related article: "Learning Disorders: Types, Symptoms, Causes, and Treatments"

5. Motor disorders

More than 30% of patients diagnosed with ADHD they usually have very rigid movements or alterations in motor coordination. The number of children with ADHD who have frequent falls or trips as a consequence of their gross motor deficiencies is significant.

• You may be interested in: "Psychomotor disorders: types, characteristics and symptoms"

Comorbidity with other disorders

These are other health alterations that often overlap with the symptoms of ADHD.

1. Disruptive behavior disorders

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

2. Anxiety disorders

With 25% comorbidity, Anxiety Disorders also greatly overlap with ADHD. The most common symptoms are excessive preoccupation with competition in certain areas, unrealistic fear of future events, or an excessive need for insurance.

• You may be interested in: "Types of Anxiety Disorders and their characteristics"

3. Mood disorders

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

4. Substance abuse disorders

One of the most common comorbid disorders in adults diagnosed with ADHD is substance use disorder. About 20-30% of patients with the latter disorder have ADHD.

When ADHD symptoms can be secondary or comorbid

In the following pathologies, the symptoms of ADHD can occur in a secondary way, or it can also present in a comorbid way. This can increase the difficulty of diagnosis., sometimes reaching a double diagnosis for a correct treatment of both problems.

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

Concluding ...

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 difficulty planning and organizing.

As I said, to carry out a proper diagnosis, it is necessary to prepare a meticulous medical history, taking into account different sources of information, assessing the nature of the symptoms that are presented to us, as well as the degree of repercussion in the different contexts of the individual that we are evaluating.

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

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