ADHD or Not? The Top 9 Conditions Commonly Mistaken for ADHD
Understanding lookalike conditions to ADHD: The Importance of an Accurate Diagnosis
Because many symptoms of ADHD are very similar to other conditions like depression, anxiety, bipolar disorder, autism and oppositional defiant disorder, all of which are also more likely to co-occur with ADHD, it can be very hard to differentiate from these disorders and others. This is why it’s essential to get a specialized assessment in order to determine exactly what is going on and what steps to take to help.
Is it ADHD or not? Deciphering the answer to that often perplexing question is key to understanding our brains and developing the strategies and support we need to succeed. Unfortunately, however, in the realm of ADHD, misdiagnosis is more common than losing socks in the dryer, often leading us off on treatment paths that end up just being a giant dead end.
The issue here is that ADHD can be a bit of a chameleon, often blending in with other conditions like anxiety, mood disorders, or autism. So, let’s get the lowdown on these lookalike conditions and try to sort through the confusion once and for all.
ADHD Diagnosis: The Fine Line Between Missing and Mistaking
The funny (definitely not roll on the floor laughing kind of funny) thing about all those overlapping symptoms is that they can lead to both over and underdiagnosis. This messy over- and under-diagnosis picture is only further complicated by factors like gender, ethnicity, socioeconomic status, and location.
All of this missed and mistaken diagnosis is particularly heartbreaking because both underdiagnosis and overdiagnosis have really serious and painful implications. Underdiagnosis means a lifetime of untreated symptoms, leading to issues like depression, low self-esteem, behavioral problems, workplace woes, and relationship troubles.
Or it can mean spending years with hackneyed cures, wondering why things aren’t getting better or easier. While overdiagnosis means unnecessary and inappropriate treatment, all while overlooking the real underlying condition.
So let’s do what we can to avoid those twin troubles and explore the 9 most common conditions that it gets mistaken for.
Which conditions are misdiagnosed as ADHD?
The 9 Most Common Lookalikes:
If ADHD is a Cameleon, it often hides out among the same crowd of 9 similarly shape-shifting characters- making it seem like a giant puzzle, trying to determine, once and for all, which one is which.
Figuring out how to distinguish which Cameleon is which means we can finally get the support and care we need and deserve because ** spoiler alert** we can’t treat what’s really going on with a misdiagnosis!
Anxiety and Mood disorders
Many folks with ADHD brains initially seek treatment for symptoms of depression or anxiety. And for good reason! It’s hard living in a world not built for your brain! And while the cameleons of depression and anxiety are VERY common playmates with ADHD, they also sometimes like to play a game of parent swap with each other- masquerading for the others.
Why?
Well, ADHD, depression, and anxiety all have a lot of symptoms in common- things like difficulties in concentration, motivation, organization, prioritization, and emotional regulation. [6]
Autism spectrum disorder (ASD)
One of the most tricky chameleon acts that ADHD does is the shapeshifting it does with Autism Spectrum Disorders. It's particularly easy to mistake them for each other, especially because they share so many traits like trouble switching gears, big feelings, and sensory sensitivities.
And just to keep things interesting, much like depression and anxiety, these two often decide to show up together! But the real kicker is that there is still so much we don’t know about Autism, particularly how it shows up in adults, and so unraveling this tangle of neurodiversity threads can be a real brain teaser.
Bipolar disorder (BD)
If you’ve been following along for a while, you know that because of the regulation differences of ADHD brains, they can be the authors of pretty big emotions. Those feelings can swing rapidly, thanks to differences in emotional regulation and the intense "fishbowl" experience of living with ADHD.
It's, therefore, no wonder that these emotional ups and downs are sometimes mistaken for bipolar disorder [8], especially in women who tend to feel ADHD's emotional impact more strongly.
And like so many of these lookalikes, this isn’t just a case of mistaken identity. Bipolar disorder is more common in ADHD brains. [9] This makes sense, given brain imaging studies show that there are shared mechanisms in the brain between the two, suggesting that they may stem from the same underlying factors [10]
Substance use disorders
ADHD brains are as desperate to soak up every drop of dopamine as a sponge left out in the desert is to drink up a lake full of water. So, it's no wonder it’s so easily lured by anything offering a quick hit of that feel-good, motivation-boosting neurotransmitter. Alcohol, cocaine, and so many other drugs (and things like sex, gambling, and gaming)... fit the bill perfectly.
The result? Brains with ADHD are twice as likely to grapple with addiction compared to their neurotypical counterparts. [11]
Here's the extra tricky part, though: addiction often takes center stage, overshadowing the underlying ADHD that drove on that desperate search for dopamine to begin with. However, overlooking ADHD in that long shadow of addiction ends up doubling down the suffering because treating ADHD not only reduces the risk of addiction [12] but also makes addiction treatment more successful.[13]
Intellectual disability and/or Giftedness
Like so many things with ADHD, this common lookalike lives in extremes. Well, the paired extremes, really, of intellectual disability and giftedness.
ADHD occurs across the full spectrum of intellectual ability. However, it is more often diagnosed in folks with an intellectual disability, and it is often missed in those with a high IQ.
Current research shows a higher rate of diagnosis of ADHD in children and adults with low IQ, but it has yet to determine if that increased rate is the result of higher symptom severity, which is causing more cases to be picked up at earlier ages or biologically based link between the two. [1]
Absence epilepsy
Absence seizures, a type of epilepsy, can look surprisingly similar to ADHD. Think: zoning out, staring into space, and struggling to focus at school or work. [14] But while absence epilepsy is less common than ADHD, it's crucial to rule it out if inattention is the primary concern, especially if there's a family history of epilepsy. Particularly given that many ADHD medications can lower the seizure threshold and increase the frequency and severity of seizures.
Oppositional defiant disorder (ODD) and Conduct Disorder (CD)
ADHD often shares the spotlight with two other conditions: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Think of ODD as the "little sibling" to CD - both involve defiance and anger, but CD takes it to a more intense level and can only be diagnosed in adults.
Many individuals with ADHD naturally experience irritability and anger, often due to the frustration of navigating a world that doesn't quite match their brain wiring. Add in ADHD's classic traits like impulsivity and a dislike of authority, and it's easy to see how these three conditions can blur together. [15]
However, like the other ADHD lookalikes we've discussed, unraveling these intertwined conditions is crucial for providing the most effective treatment and support. Each condition requires a tailored approach to help individuals thrive.
Trauma exposure
The connection between trauma and ADHD is a tangled web. People with ADHD are more prone to experiencing trauma in all its forms [3], and when trauma strikes, it can intensify existing ADHD symptoms.[4]
Adding another layer of complexity, trauma often masquerades as ADHD, with symptoms like hypervigilance, distractibility, and emotional rollercoasters. These symptoms can also mimic many of the other conditions we’ve mentioned already, like bipolar disorder, borderline personality, or oppositional defiant disorder, leading to the many frequent misdiagnosis of ADHD in individuals who have experienced trauma.
This underscores the importance of a comprehensive assessment that delves into personal history and symptoms. Only by understanding the complete picture can we accurately diagnose and effectively treat individuals who are grappling with both trauma and ADHD.
Sleep disorders
Most ADHD brains can tell you that sleep issues are common bedfellows (yup- you’re welcome for that fabulous pun!). But it’s true-ADHD brains are not brains that sleep well!
While most researchers believe that sleep issues arise from the regulation differences of ADHD brains or from a shared neurological basis of ADHD and sleep issues, a group of researchers from Denmark sparked a fervent debate not too long ago by suggesting some ADHD diagnoses might actually be a case of mistaken identity, misattributing sleep problems as ADHD.
Why do all the sleep and ADHD overlap and debate?
Well, sleepy brains look a whole lot like ADHD brains- with impaired concentration, focus, and emotional regulation. In fact, as one famous study recently displayed, missing just 1 hour of sleep a night for a week (and let’s be honest- who hasn’t missed 1 hour of sleep for a while?!?) results in clinical levels of inattention and cognitive impairment. [5]
But like so many of the other disorders we mentioned- it's not just that sleep disorders look like ADHD, but ADHD can cause sleep disorders (and very often does!), making this yet another puzzle essential to figure out so we can all get the rest we deserve.
The Importance of a Specialized Diagnosis
It’s really easy to scroll through ADHD TikTok, nod along, and think, “Yes! That’s me! I tick all the boxes!” While that initial sense of “being seen” and its subsequent research can feel like opening a magic glowing box filled with all the answers, getting a specialized diagnosis is still (and maybe all the more) an essential step because of this crowded, complicated picture full of lookalike chameleons.
But it’s not just that there are so many lookalike conditions that make differentiating exactly what’s what tricky. It’s also that ADHD can look so very different in different people, at different ages, and in different cultures and settings. It’s therefore extra essential to sort through all the possibilities with a nuanced and expert lens and tools that can help to differentiate exactly what’s at play.
Crack the ADHD Diagnosis Puzzle: How to get an Accurate Diagnosis:
Let's be real: Given all these lookalike chameleons, figuring out if you have ADHD can feel like navigating a maze with your eyes closed! You know you need a specialist, but finding the right one can seem like an epic quest. Don't worry; let’s walk through the labyrinth together!
Online Screeners: A Quick Peek
A great first step is to start with an quick online screening test – it's like a sneak peek into your brain! While it won't give you a definitive answer, it's a great way to see if ADHD might be on your radar. Think of it as a quick first step rather than a final verdict.
The Right Evaluation for YOU
Next up: choosing the right kind of evaluation. But hold on – before diving in, ask yourself: Why do I want a diagnosis?
Accommodations for school or work? A psychologist offering a comprehensive evaluation is your go to here.
Medication? A psychiatrist might be the answer, or a GP can sometimes use a psychologist's assessment as well.
Just curious about yourself? Either a psychologist or psychiatrist can help you unlock that mystery.
Still unsure? Check out our guide on "How to Get Tested for ADHD" – it'll help you find the perfect match for your needs.
Finding Your ADHD Guru
Ready for the trickiest part? Finding a psychologist or psychiatrist who not only offers evaluations but really gets ADHD. Ideally, they'll have experience with people like you – similar age, background, and life stage and a long history distinguishing ADHD from its many counterparts.
A great resource is Psychology Today. It's like a search engine for therapists, letting you filter by specialty, location, and even insurance. But remember, don't just rely on the website – interview potential specialists to ensure they're the right fit for you.
If you're in the US, the experts at The Center for ADHD (yes, we're biased but also awesome) can help you figure out the best path forward and offer convenient, thorough, highly specialized assessments and treatment online.
Take the Next Step!
No matter what, finding the right specialist is key to navigating the ADHD diagnosis maze. An accurate diagnosis is like a treasure map – it leads you to the best treatment and support for your brilliant brain.
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