ADHD Differential Diagnosis

1. See Also
   1. Attention Deficit Disorder in Children
   2. School Problem Evaluation
   3. Attention Deficit Disorder in Adults
   4. ADHD Diagnosis
   5. ADHD Comorbid Conditions
   6. ADHD Non-Pharmacologic Management
   7. ADHD Medications
   8. Dextroamphetamine (Dexedrine, Dextrostat, Adderall) or Lisdexamfetamine (Vyvanse)
   9. Methylphenidate (Ritalin, Methylin, Concerta)
   10. Atomoxetine (Strattera)
2. Associated Conditions
   1. Language and Learning Disability (10-15%)
      1. Usually less hyperactive and more inattentive
   2. Tourette's Syndrome (70% with tics have ADHD)
   3. Oppositional Defiant Disorder (35-65% of ADHD patients)
   4. Conduct Disorder (10-20% of ADHD patients)
   5. Major Depression (20% of ADHD patients)
   6. Anxiety Disorder (25% of ADHD patients)
   7. Substance Abuse (20-40% of ADHD patients)
3. Differential Diagnosis: Psychiatric Conditions
   1. Low self esteem
   2. Major Depression
   3. Bipolar Disorder
   4. Dysthymia
   5. Anxiety Disorder
   6. Obsessive Compulsive Disorder
   7. Separation Anxiety
   8. Conduct Disorder
   9. Oppositional Defiant Disorder
   10. Obsessive Compulsive Disorder
   11. Poor Social skills
   12. Substance Abuse
       1. Consider if symptom onset in adolescence
4. Differential Diagnosis: Medications
   1. Anticonvulsants
   2. Antihistamines
   3. Decongestants
   4. Beta agonists
5. Differential Diagnosis: General Medical Conditions
   1. Hypothyroidism
   2. Severe Anemia
   3. Lead Poisoning
   4. Chronic illness
   5. Hearing Impairment or vision Impairment
   6. Obstructive Sleep Apnea in Children
6. Differential Diagnosis: Neurologic Conditions
   1. Sleep disorders
      1. Obstructive Sleep Apnea
      2. Restless Leg Syndrome
      3. Periodic Limb Movement disorder
      4. Insomnia
   2. Tourette's Syndrome (and other Tic Disorders)
   3. Seizure disorder (e.g. Absence Seizure)
   4. Sensory disorders
      1. Vision disorder
      2. Hearing Loss
   5. Intellectual Disability (Mental Retardation)
      1. Fragile X Syndrome
      2. Fetal Alcohol Syndrome
      3. Phenylketonuria
      4. Neurofibromatosis
      5. 22q11 Deletion Syndrome
   6. Miscellaneous Causes
      1. Autism Spectrum Disorders
      2. Speech or language disorders
      3. Other Developmental Disorders
      4. Specific Learning Disorders (e.g. math, reading)
      5. Closed Head Injury
7. Differential Diagnosis: Environmental
   1. Unsafe or disruptive learning environment
   2. Bullying
   3. School curriculum not well matched to child's ability
   4. Family dysfunction or poor parenting
   5. Child Abuse or neglect
   6. Parental Psychopathology
   7. School Maladaptive Behavior (e.g. suspension or expulsion)
8. References
   1. Biederman (1991) Am J Psychiatry 148:564-77 [PubMed]
   2. Chang (2020) Am Fam Physician 102(10):592-602 [PubMed]
   3. Felt (2014) Am Fam Physician 90(7): 456-64 [PubMed]
   4. Fletcher (1999) Pediatr Clin North Am 46:885-96 [PubMed]
   5. Goldman (1998) JAMA 279:1100-7 [PubMed]
   6. Hazel (1997) J Paediatr Child Health 33:131-7 [PubMed]
   7. Smucker (2001) Am Fam Physician 64:817-32 [PubMed]
   8. (2006) J Clin Psychiatry 8(4):224-33 [PubMed]