Is your child being misdiagnosed with ADHD?

There are various ADHD symptoms in kids, which makes it easy to confuse it with other conditions

By Amy Wilkinson | Updated on Apr. 24, 2024 Medically reviewed by Michael L. Davis, MD & Laura K. Grubb, MD, MPH

Does your daughter seem to have boundless energy, running circles around all of her peers? Or does your son seem to have a hard time concentrating in class, earning poorer than expected grades? It’s hard for a parent to know whether behaviors like these are symptoms of ADHD—or simply kids being kids. Getting an accurate ADHD diagnosis for your child from a mental-health professional could mean the difference between just getting by and growing up with confidence.

What is ADHD?

Attention deficit hyperactivity disorder is a neurodevelopmental disorder “characterized by a pattern of behavior, present in multiple settings (e.g., school and home), that can result in performance issues in social, educational, or work settings,” according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These patterns of behavior are divided into either inattention or hyperactivity-impulsivity and include symptoms ranging from failure to listen or follow instructions to fidgeting or excessive talking.

The cause of ADHD is unknown, according to Diana Deutsch, MD, a Brooklyn-based psychiatrist, though she says that there is a suspected hereditary component at play.

“You’ll often see a child who has this, and the father will say, ‘Oh, well, I had that when I was a kid,’” she explains, adding that while you are likely born with ADHD, environmental factors can also have an effect on the condition. These environmental factors can include bullying, inconsistent routines, boredom, and possibly diet.

The fact that ADHD is associated with a big increase in deaths makes it even more important to establish a correct diagnosis. The increase in deaths is mostly from accidents, but suicides and drug overdoses are also more common in both kids and adults with ADHD.

ADHD symptoms

The symptoms of ADHD fall into two categories: inattention and hyperactivity-impulsivity, with most kids having a combination of both, according to Dr. Deutsch.

Typical inattention symptoms include:

Difficulty sustaining attention
Getting distracted easily
Not paying attention to details
Making careless mistakes
Struggling to finish assignments or follow directions
Losing or forgetting things

Typical hyperactivity-impulsivity symptoms include:

Acting before thinking
Restlessness and fidgeting
Talking a lot or interrupting people at inappropriate times.

These symptoms must present in a child before the age of 12 and cause disruption in their life, in order for an ADHD diagnosis to be reached. For children younger than 17, the diagnosis requires at least 6 symptoms for at least 6 months and for those ages 17 or older, the diagnosis requires at least 5 symptoms for at least 6 months.

To that end, if as an adult, you suddenly find yourself having difficulty concentrating, there are a lot of other conditions (such as anxiety or depression) that your provider will likely rule out first. Though, it’s common for an adult to have had ADHD as a child and have it persist into adulthood. In these cases, Dr. Deutsch says the symptoms may look much the same in adulthood, though the vocabulary used to describe them will likely be a little different.

“There isn’t a pediatric ADHD list of symptoms in the DSM versus an adult list,” she says. “However, it often presents differently. You could have a spouse saying, ‘My husband goes from one thing to the next and it’s hard for him.’ Or sometimes a young adult will come in and say, ‘I know I’ve always had this difficulty, but no one ever took me [to the doctor], or I was smart enough that I managed.’”

What can ADHD be mistaken for?

There are several conditions that mimic ADHD symptoms in kids, such as the following:

Anxiety disorders
Depression
Stress response
Sleep disorders or poor sleep hygiene
Substance use
Learning disabilities, such as dyslexia
Hearing problems
Autism spectrum disorder
Oppositional defiant disorder
Sensory processing disorder
Bipolar disorder

These conditions often occur alongside ADHD. When diagnosing ADHD, providers should be careful not to conflate ADHD symptoms with other mental-health issues, such as anxiety disorders or mood disorders. “Anyone who’s ever been anxious, which is everyone, knows it’s impossible to pay attention when you’re really anxious,” Dr. Deutsch says. “You cannot focus.”

Developmental disorders, such as learning disabilities and autism spectrum disorders, should also be ruled out. “The other thing is sometimes a kid is just academically mismatched,” Dr. Deutsch says. “This is very important. Somebody’s kids will come home and they’ll say they’re bored, but actually maybe they have a learning disability.”

It is possible for a child to have both a developmental disorder and ADHD (or anxiety/depression and ADHD), so there is a lot of nuance involved in accurately diagnosing the underlying issue(s). That’s why it’s important to have a specialist determine the cause of ADHD-like symptoms. For school-aged children, adolescents and college students, it is important to seek an educational evaluation to achieve the proper diagnosis and important educational accommodations.

How often is ADHD misdiagnosed?

The estimated number of children to ever be diagnosed with ADHD, per a 2016 parenting survey cited by the Centers for Disease Control and Prevention (CDC), is 6.1 million. Yet, a 2017 study published in Child and Adolescent Psychiatry and Mental Health suggested that around 1.1 million children in the United States have “received an inappropriate diagnosis” of ADHD.

RELATED: ADHD statistics

Why does ADHD misdiagnosis happen?

The study listed a number of potential reasons for the misdiagnosis of ADHD in children including:

Having a birthdate close to the kindergarten cut-off date. Often, these immature students’ behaviors are compared to their relatively more mature classmates’ behavior in order to reach a diagnosis. (Essentially, while all the students are in kindergarten, the 5-year-old’s actions will likely be less savvy than the 6-year-olds’ actions.)
Providers coming to their own conclusions and not properly utilizing the diagnostic methodologies outlined in the DSM-5.
Symptoms of ADHD mimicking those of other conditions, or a patient presenting with multiple conditions, making the diagnosis more complicated.
Pressure from parents to make this diagnosis instead of exploring parenting or lifestyle issues

While overdiagnosing is an often-discussed problem with ADHD, less attention is paid to the phenomenon of underdiagnosing. Girls and adolescent young women are typically diagnosed less frequently, often because their symptoms aren’t the more noticeable hyperactive kind and they are able to compensate well enough.

“Smart girls are the most overlooked group, who I get to see when they are 27 years old,” says Owen Muir, MD, a psychiatrist and co-founder of Brooklyn Minds. “Nobody cares if you’re getting an A not an A+, or if you’re a girl, and you’re getting a B+, especially if you’re quiet. And so quiet girls who have inattentive type ADHD and are very smart, there’s not enough difficulty range in grade school or high school to make it matter. They can do those things in their sleep. They can be tremendously impaired, but If they’re smart enough, it doesn’t matter—until you get to the point where you hit the wall.” And that point is when the demands outstrip their ability to deal with them, prompting a diagnosis much later in life.

Living with undiagnosed (and, therefore, untreated) ADHD can have major consequences, from low self esteem and difficulty at work to relationship problems—even attempted suicide.

Properly diagnosing ADHD

If your child or adolescent is exhibiting symptoms of ADHD, it’s important to take them to a medical professional for testing. The first step, according to the CDC, is typically a simple medical test to check their vision and hearing to rule out any physical conditions that could mimic the symptoms of ADHD. After that, a mental health professional will likely conduct a series of interviews, with parents, teachers, and the child, to really get a sense of what the issues are and how they are affecting the child’s school and home life.

“It really is a clinical diagnosis,” says Dr. Deutsch. “But in order to make it, we have to put in a lot of pieces that aren’t clinical. But mostly it’s the list. It’s performance: Why is this child not doing what you would expect? Why is this person having so much difficulty in this academic setting? It’s like being a detective.”

There is not one test to diagnose ADHD and the best approach is comprehensive neuropsychological or educational evaluation. The assessment may include observational forms for the parents and teachers to complete, known as the Vanderbilt forms. The optimal testing age range, according to the American Academy of Pediatrics, is 4 to 18 years of age.

ADHD treatment

Treatment for ADHD falls into two categories: behavioral and pharmacological. Depending on the child’s age and needs, they will often be used in tandem to treat the disorder.

How do you treat ADHD without medication?

Behavioral treatment is usually the first step for very young children (ages 4 and 5) diagnosed with ADHD. This often takes the form of parent training. “Parents have to understand that they need to positively reinforce the good behavior they see,” says Dr. Deutsch. Parents also learn how to break down large tasks into smaller steps. In order for their child to successfully follow along, each step should be accompanied by more positive reinforcement. For older kids, behavioral treatment may also include some form of therapy. Mental health professionals may also consult with a student’s teachers to devise the right kind of learning plan for them. Other important considerations include: providing clear expectations, using a consistent routine, ensuring adequate sleep, setting age-appropriate goals, breaking tasks up into smaller chunks, giving lots of praise and rewards, and communicating frequently with school staff.

What is the best medicine for ADHD?

ADHD medications fall into two categories: stimulants and non-stimulants. “First line is stimulants,” says Dr. Deutsch. Stimulant medications (which are usually methylphenidate or amphetamine-based) include drugs like Adderall, Ritalin, Concerta, and Dexedrine. According to the Food and Drug Administration (FDA), “they are believed to increase brain levels of dopamine—a neurotransmitter associated with motivation, attention, and movement,” which has a calming effect. If children cannot take a stimulant (perhaps because of another underlying condition), they will then be prescribed a non-stimulant drug such as Strattera (atomoxetine), Intuniv (guanfacine), or Kapvay (clonidine).

These drugs can have side effects, and there is no one-size-fits-all treatment plan for ADHD, so it’s important to work with your child’s physician to tailor a treatment plan for them, which may need some tweaking along the way.

While ADHD cannot be cured, it can be well-managed. Many people with the condition build such effective coping strategies that they no longer need medication as adults.