Is It ADHD or Something Else?

Most caretakers may be aware of the three major symptoms of ADHD: inattention, hyperactivity and impulsivity. However, not every child with ADHD exhibits all of these symptoms, as there are multiple types of ADHD: Primarily Inattentive (formerly known as ADD); Primarily Hyperactive and Impulsive; and Combined, where all three symptoms are at play.

Further complicating matters, a diagnosis is not as clear-cut as simply identifying symptoms. Problems such as a learning disability, anxiety, a sleep disorder, trauma or other issues may cause a child to exhibit ADHD symptoms. In some cases, a child may have a comorbidity, or ADHD along with another type of disability.

Because ADHD often occurs in conjunction with other disorders, the American Academy of Pediatrics recommends that “Every child with ADHD should be screened for other disorders and problems” (cdc.gov). Assuming an inattentive or hyperactive child has ADHD, and ADHD alone, may lead to a misdiagnosis or incomplete diagnosis. For example, trauma, which can be anything from abuse to major life changes, often can cause a child’s behavior to mirror ADHD.

Trauma and ADHD: Overlapping Symptoms

Tulsa’s Child Abuse Network (CAN) recently shared information from the Child Mind Institute on social media that gave an overview of signs of trauma that can be confused with ADHD. For example, a child with a history of trauma may experience hyperarousal – being on high alert for signs of danger – which may result in the child having difficulty sitting still and focusing in class.

Sarah Beilke, CAN vice president and COO, elaborates, “I think the signs that overlap the most have been difficulty concentrating and learning at school.”

Being exposed to trauma, she explains, can lead to the child dissociating or feeling overwhelmed. They may be easily distracted, which can resemble the inattentiveness or the hyperactivity associated with ADHD. Children who have experienced trauma may also have anxiety, causing them to act restless like a child with ADHD. To an observer, the symptoms look the same, but the root causes are very different.

The fact that there is so much symptom overlap – between ADHD, anxiety, trauma and other conditions – can make diagnosis difficult.

“Some kids absolutely do have both [ADHD and signs of trauma],” Beilke says. “You have to be really focused and specialized in your treatment to make sure you’re managing both things at the same time.”

Looking Through a Trauma-Informed Lens

A mental health provider can provide the thorough assessment necessary to determine whether a child has ADHD, symptoms resulting from trauma, or both. However, one thing a parent or teacher could look for, Beilke says, is the timing of the symptoms.

“If you are aware of any major life changes in a child’s life, you need to try to view that through a trauma lens,” Beilke says.

If a child who hasn’t previously exhibited signs of ADHD suddenly starts showing symptoms, consider any stressors in their life before assuming ADHD is the cause of the behavior.

Although Child Abuse Network works with children who have experienced the trauma of abuse in particular, Beilke cautions that, to a child, even events like a move or living through a tornado can be traumatic.

“When you think about a child, especially the younger they get, anything that’s outside their normal, everyday world could be perceived as traumatic because they just haven’t had as many days on earth. So their frame is different from ours as an adult.”

Beilke says that, in her experience as a school-based therapist, the trauma aspect may often be missed because people are more trained to associate inattentiveness and hyperactivity with ADHD. However, she thinks the field is improving. More professionals in the field are considering the entirety of a child’s situation rather than just the behaviors they’re exhibiting. (Learn more at traumainformedcare.chcs.org.)

The Importance of a Correct Diagnosis

For children with ADHD, getting diagnosed and finding an effective treatment option can lead to greater success in school and relationships. And for a child who has experienced trauma of any kind, getting them the correct diagnosis and treatment is vital.

“The amazing thing that comes from working around trauma is the ability people have to heal from those events if given proper resources and support,” Beilke says. “It’s so important to give kids and adults those resources so they have the opportunity to heal and live happy and healthy lives.”

For further reading, see Mary Beth Ritchie, LCSW’s articles at tulsakids.com/adhd-doesnt-always-have-a-hyperactivity-component and tulsakids.com/when-high-iq-and-adhd-collide.

Common Coexisting Conditions in Children with ADHD

Learning disabilities

• Frequency: 30-50% of children with ADHD also have a learning disability (chadd.org)
• Can be diagnosed through evaluations like IQ and academic achievement tests

Oppositional defiant disorder/conduct disorder

• Frequency: Up to 35% of children with ADHD also have oppositional defiant disorder or conduct disorder
• Pediatrician may recommend that the child see a behavioral therapist

Mood disorders/depression

• Frequency: Approximately 18% of children with ADHD also have a mood disorder
• See a mental health specialist

Anxiety disorders

• Frequency: About 25% of children with ADHD also have an anxiety disorder
• Counseling and/or medication may be needed for treatment

Language Disorders

• Frequency: About 30% of people with dyslexia may also have ADHD (dyslexiada.org)
• Child may need to see a speech and language clinician

Current data indicates that about 9.4% of children ages 2-17 in the U.S. are affected by ADHD. If you think your child may have ADHD, talk to your pediatrician. They should be able to assess your child’s behavior and interactions in school, with peers, etc., and make referrals as necessary. You can also contact an ADHD specialist through Children and Adults with Attention-Deficity/Hyperactivity Disorder (CHADD), by calling 1.866.200.8098.

Information provided by healthychildren.org