How do you differentiate ADHD from other possible disorders?

You may have seen or heard the acronym ADHD, but … Do you know what Attention Deficit Hyperactivity Disorder is and how to distinguish it from other disorders?

ADHD is a neurobiological disorder that usually starts in childhood and can also be present in adolescence or adulthood.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is classified as a neurodevelopmental disorder. The nuclear symptoms are: attention deficit, hyperactivity and / or impulsivity.

    What does ADHD look like?

    Typically, people with ADHD may exhibit the following cognitive or behavioral characteristics: difficulty concentrating and persevering, problems planning or organizing tasks, complications in establishing self-control (inhibition of thoughts or actions), deficit in working memory, difficulty identifying / recognizing emotions or problems with social interaction.

    Different variables need to be taken into account when diagnosing a child with ADHD because we tend to label them quickly when we see a restless or inattentive child, but we have to remember that this is a disorder. chronic, which consists of a structural, functional and connectivity disorder between different areas of the brain.

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

    In this regard, each case must be assessed individually, explore, in addition, the presence of comorbidity with other disorders and a possible differential diagnosis, because nuclear symptoms may be present in other pathologies. In this sense, these symptoms can be secondary to other disorders, comorbidities or both. We will see in more detail below.

      Differential diagnosis

      In this regard, each case should be assessed individually, also exploring the presence of comorbidity with other disorders and a possible differential diagnosis, as nuclear symptoms may be present in other pathologies.

      In this way, these symptoms may be secondary to other disorders, comorbidities, or both. We will see in more detail below.

      Secondary symptoms of ADHD a environmental factors:

      • Stressful environmental situations or contexts.
      • Fickle caregivers.
      • Situations of neglect and / or abuse and / or abuse of children.
      • Poor sleep hygiene.
      • Malnutrition.

      Secondary symptoms of ADHD a other diseases:

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

        What are the comorbid pathologies of ADHD?

        On at least half of patients diagnosed with ADHD have a comorbid disorder. Therefore, at the time of diagnosis, possible co-morbidities should be considered, as the presence of other disorders (added to the diagnosis of ADHD) may influence the initial clinical presentation, the course of symptoms and the response to intervention.

        Comorbidity with neurodevelopmental disorders

        If ADHD is diagnosed, the presence of other neurodevelopmental disorders and vice versa should be explored.

        1. Disorders of intellectual development

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

          2. Communication disorders

          Different studies have described a strong comorbidity between the disorder of social or pragmatic communication with other disorders, such as ADHD.

          3. Autism Spectrum Disorders (ASD)

          The latest edition of the DSM (DSM-5) allows a person to be diagnosed with both disorders, ASD and ADHD, when this was not possible before.. They both share certain symptoms and appear to share the same deterioration; they present alterations in executive function, although with different nuances.

          For example, children with ADHD exhibit deficits in inhibitory control, while children with ASD have severe problems with cognitive flexibility and planning, typically retaining inhibitory skills.

            4. Specific learning disabilities

            Its comorbidity with ADHD is approximately 20%. Academic difficulties resulting from problems integrating knowledge is one of the characteristics most clearly associated with ADHD.

            However, ADHD and learning disabilities are different entities that can occur simultaneously, standing apart. For example, children with ADHD tend to be more variable in their performance, as they are often dependent on environmental conditions.

              5. Motor disorders

              Over 30% of patients diagnosed with ADHD they usually have very stiff movements or impaired motor coordination. The number of children with ADHD who experience frequent falls or trips due to gross motor impairment is significant.

                Comorbidity with other disorders

                These are other health conditions that often overlap with ADHD symptoms.

                1. Disruptive behavioral disorders

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

                2. Anxiety disorders

                Anxiety disorders also overlap with ADHD with 25% comorbidity. The most common symptoms are an excessive preoccupation with competing in certain areas, an unrealistic fear of future events, or an excessive urge to insure.

                  3. Mood disorders

                  Co-morbidity is 30%. More serious depressive disorders are more common in children with ADHD than in the general population. Feelings of disability, incapacity or low self-esteem develop, as well as depressed mood or disturbed sleep and eating.

                  4. Substance abuse disorders

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

                  When ADHD symptoms may be secondary or co-morbid

                  In the following conditions, the symptoms of ADHD may be secondary, or they may also be co-morbid. This can increase the difficulty of diagnosis, sometimes even doubly diagnosed for the correct treatment of both problems.

                  • Cranio-encephalic trauma.
                  • Acquired brain damage.
                  • Epilepsy.

                  • Sleep disorders.
                  • Fetal alcohol syndrome.

                  • Genetic syndromes: X-fragile, Prader-Willi, Klinefelter, etc.

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                  Conclusion…

                  In short, ADHD goes beyond a child who behaves badly, does not listen or is very nervous, or someone who is not careful or has difficulty planning and organizing.

                  As I said, to make a correct diagnosis, it is necessary to meticulously prepare a medical history, taking into account the different sources of information, assessing the nature of the symptoms presented to us, as well as the degree of impact on the different contexts of the person we are evaluating.

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

                  Author: Maribel Martín, general health psychologist at the Psychology Report Center.

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