Conditions That Mimic or are Comorbid With ADHD
A 2007 study by the National Survey of Children’s Health (NSCH) found that most children with ADHD (67%) have at least 1 other comorbid condition, and 18% have 3 or more comorbidities such as mental health disorders and/or learning disorders.1 These comorbidities increase the complexity of the diagnostic and treatment process.
It is important that the PCC determine if symptoms are due to alternative causes before confirming the diagnosis of ADHD. It is also necessary to determine if the patient has an additional condition or conditions. If other conditions are suspected or detected during the diagnostic evaluation, an assessment of the urgency of these conditions and their impact on the ADHD treatment plan should be made.
Examples of conditions that mimic, are comorbid with ADHD, or contribute to the cause of ADHD include but are not limited to the following:
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Type
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Examples
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Medical
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Vision/hearing, anemia, medicine side effects, thyroid disorders, seizures, sleep apnea, and restless leg syndrome are examples of medical conditions that should be treated first to see if the treatment addresses the ADHD symptoms.
Sequelae of central nervous system hypoxia, prematurity, intrauterine growth restriction (IUGR), and small for gestational age (SGA) syndromes, medical syndromes (Fetal Alcohol Specturm Disorder [FASD], Fragile X, etc), traumatic brain injury, central nervous system infections, and near-drowning are examples of medical issues that should be treated along with ADHD.
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Developmental
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Autism, speech/language and specific learning disorders, intellectual deficits, tic disorders, developmental coordination disorders, motor delays, sensory processing disorders
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Behavioral/emotional
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Anxiety, depression, oppositional defiant disorder, conduct disorder, bipolar disorder, reactive attachment disorder, disruptive mood dysregulation disorder, post-traumatic stress disorder, obsessive-compulsive disorder
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Family/environmental
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Family separation, divorce, death, adverse events, exposure to violence, physical abuse/neglect, sexual abuse
In the school environment: bullying, poor school or teacher fit, giftedness
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Substance use
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Alcohol, marijuana, and other illicit substances or misuse of prescription medication
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Of Special Importance
- Urgent conditions that put the patient’s health at risk (eg, depression with suicidal ideation, high-risk behaviors, and substance use) need to be addressed immediately with providers capable of handling them. Frequent, ongoing assessment is essential, and the impact of such conditions on the ADHD treatment plan should be considered.
- If symptoms arise suddenly without prior history, it is important to consider other conditions, including but not limited to the following: mood or anxiety disorders; substance use; head trauma; physical or sexual abuse; neurodegenerative disorders; sleep disorders (including sleep apnea); or a major psychological stress in the family, community (eg violence), or school (eg bullying).
- The PCC may evaluate and treat the comorbid disorder if it is within the PCC’s expertise. If the advice of another subspecialist is required, the PCC should carefully consider when to initiate treatment for ADHD. In some cases, it may be advisable to delay the start of medication until the full care team is established/consulted.
- The evaluation, diagnosis, and treatment of ADHD and its comorbid conditions are a continuous process. PCCs should be aware of the need for reassessment at every visit.
1Larson K, Russ SA, Kahn RS, Halfon H. Patterns of comorbidity, functioning and service use for US children with ADHD, 2007. Pediatrics. 2011;127(3): 462-470