Current trends show the number of North American children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) continues to rise. Recent parent-reported data collected by the National Survey of Children’s Health (NSCH) indicated the incidence of U.S. children aged 4-17 diagnosed with ADHD increased by an astounding 42 percent between 2003 and 2011.
As a result of these numbers, researchers have begun to investigate the possibility of misdiagnosis of what is becoming a very common disorder.
In her recent article for Harvard Medical School’s blog, Harvard Health Publishing, Faculty Editor Claire McCarthy, M.D., explained that “one in 10 children between the ages of 4 and 17 has been diagnosed with [ADHD].” With these statistics, McCarthy said, it is understandable “when parents notice that their child has trouble concentrating, is more active or impulsive than other children, and is having trouble in school, they think that their child might have ADHD.”
According to the CNN.com Health page, “Children and adults with ADHD exhibit characteristic behaviors which fall into three common behavioral groupings,” including inattention, hyperactivity, and impulsiveness.
But, McCarthy cautioned, ADHD is not the only issue that results in a child with difficulties in behavior, concentration or school success. “There are actually lots of problems that can cause symptoms that mimic ADHD,” she wrote. McCarthy pointed to five familiar problems that should be ruled out by parents, their family doctors, and specialists before jumping to conclusions or assuming a child has ADHD.
- Difficulties Hearing.
Children who cannot hear well may appear distracted or inattentive—behaviors that can be mistaken for one of the common symptoms of ADHD. Although newborns are screened for hearing problems, some hearing losses can be overlooked and children can acquire hearing problems later in life from illnesses, high fevers or ear infections. McCarthy suggested, “Any child with behavioral or learning problems should have a hearing test to be sure their hearing is normal.”
- Learning or Cognitive Disabilities.
Children who have difficulty understanding the activities and lessons in class may seem unwilling or fail to participate or may be unable to focus on tasks. Learning or cognitive challenges may also cause a child difficulty in student-student and student-teacher interactions since such communications may be “very quick, complex, and nuanced”.
McCarthy recommended evaluating the challenges and needs of any child who seems to be progressing poorly and establishing Individualized Education Programs (IEPs) for a child’s specific needs. “Parents should talk to their child’s teacher and their pediatrician for guidance,” advised McCarthy.
- Sleep Problems.
Children suffering a lack of sleep, or a lack of quality sleep, may exhibit characteristics like those of ADHD—with behavioral issues or difficulty learning and retaining information. McCarthy suggested parents who notice repetitive nights of snoring from a child not suffering from congestion from a cold or flu, should see a doctor. She also warned parents who notice a child making choking sounds or pausing their breathing while asleep.
The amount and quality of a teen’s sleep should also be monitored to ensure they avoid late-night homework and turn off phones early enough to get a minimum of eight hours sleep. Most importantly, wrote McCarthy, is that “any time a diagnosis of ADHD is being considered, it’s important to take a close look at a child’s sleep and make sure there aren’t any problems."
- Mental Health Issues.
With greater recognition and respect given to mental health issues, the number of adolescents seeking professional assistance for depression and anxiety is on the rise. However, even with positive media attention, there are still too many cases of child and youth mental health disorders that remain undiagnosed and untreated.
For those suffering from depression, anxiety, or other mental health challenges, classroom behavior may imitate symptoms of ADHD. Some children act out, others withdraw. As a result, McCarthy urged that in “any evaluation for ADHD, a child should also be evaluated for other mental health issues, not just because they can mimic ADHD, but because other mental health issues can occur with, or because of, ADHD.”
- Substance Abuse.
McCarthy noted that for a child or adolescent to receive a diagnosis of ADHD, symptoms must have presented before age 12. Thus, while it may be hard to question alcohol or illicit drugs, parents of a child whose debatable symptoms were not present earlier in childhood should rule out substance abuse before suspecting ADHD.
In addition to McCarthy’s five suggestions, an October 2017 article on Canada’s HuffPost on research from the University of Nottingham in the U.K. and Finland’s University of Turku found younger children in classrooms “were more likely to be diagnosed with ADHD than their older peers in the same school year”. With school starting in the month of August in Finland, the youngest children are those born in December. The oldest are those born in January.
Kapil Sayal, professor of child and adolescent psychiatry and lead author of the study, explained: "With an age variation of up to 12 months in the same class, teachers and parents may misattribute a child's immaturity. This might lead to younger children in the class being more likely to be referred for an assessment for ADHD.”
And the results of a retrospective study published by researchers at the University of Birmingham, Alabama, School of Medicine in 2016 recognized the diagnosis of children with ADHD was higher in those with “uncorrectable vision problems” or impaired vision and believed misdiagnosis might explain the higher numbers.
Lead author Dawn DeCarlo, O.D., with the university's Department of Ophthalmology, said, “It could be as simple as children with vision problems being mislabeled as ADHD because they are not able to pay attention to things they cannot see.”
The bottom line, concluded Claire McCarthy in her Harvard article, is that many issues can result in a child presenting behavioral and attention difficulties. “Any child who is showing those difficulties deserves a thoughtful, thorough evaluation,” she wrote, “to be sure that they get the right diagnosis and the best treatment.”
CNN.com. (Retrieved January 27, 2018). ADHD. http://www.cnn.com/HEALTH/condition.clinic/adhd.html
HuffPost Canada. (October 11, 2017). ADHD Is Over-Diagnosed In The Youngest Children In A Class: Study. http://www.huffingtonpost.ca/2017/10/11/adhd-misdiagnosis-younger-children_a_23240468/
McCarthy, C., M.D., (January 9, 2018). Harvard Health Publishing. 5 common problems that can mimic ADHD. https://www.health.harvard.edu/blog/5-common-problems-that-can-mimic-adhd-2018010913065
Melton, C., ELS., (May 25, 2016). Psychiatry Advisor. Children With Vision Problems More Likely to be Diagnosed With ADHD. https://www.psychiatryadvisor.com/adhd/adhd-diagnoses-more-prevalent-in-children-with-vision-problems/article/498677/
National Institute of Mental Health. (November 2017). Attention-Deficit/Hyperactivity Disorder (ADHD). https://www.nimh.nih.gov/health/statistics/attention-deficit-hyperactivity-disorder-adhd.shtml
Sayal, K., Ph.D., (October 9, 2017). The Lancet, Psychiatry. Relative age within the school year and diagnosis of attention-deficit hyperactivity disorder: a nationwide population-based study. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30394-2/fulltext