The Importance of Differential Diagnosis

Here is an article that I found today on AOL.  It brings up a very important point which is that ADHD is most likely over-diagnosed in this country.  It is a disorder that shares overlapping symptoms with other diagnoses which reinforces how important appropriate, expert diagnosis is when assessing one’s symptoms.  Especially when dealing with children and the prospect of using medications, it is incredibly important to get the diagnosis right!  This article highlights this point:

Nearly 10 percent of children and 4 percent of adults in the U.S. have been diagnosed with ADHD. But studies suggest that while many people with ADHD still go undiagnosed, others are wrongly diagnosed with ADHD when they are instead suffering from a range of other disorders. The most common cause of misdiagnosis is a misunderstanding of what ADHD really is, according to Dr. Russell Barkley, clinical professor of psychiatry at the Medical University of South Carolina and author of “Taking Charge of ADHD: the Complete, Authoritative Guide for Parents.” “People rather superficially see that someone has difficulty paying attention and think they may have ADHD,” he says. “But the differential diagnosis of ADHD is not based on inattention — it’s based on the other deficits that go along with inattention: lack of self control, heedlessness, recklessness, thoughtlessness, an inability to think of what you’re doing before you do it.” So which conditions are most often mistaken for ADHD, and how can such misdiagnoses be avoided?Autism
“ADHD is rarely misdiagnosed as autism, but sometimes autism can be misdiagnosed as ADHD in its early stages,” says Barkley. That’s because the two conditions overlap, according to studies. Forty percent of autistic children have ADHD, and a portion of ADHD children have some autistic traits. Parents and practitioners often pick up on one condition but not the other. Barkley cautions parents and doctors to look for the signs of autism. Children with autism are not merely inattentive: They may have problems with language, stand too close to others, find social situations awkward or completely uninteresting, be unable to make eye contact, or engage in behaviors like hand flapping.

Bipolar Disorder

ADHD symptoms are present in people suffering from bipolar disorder, especially during the manic phase of the illness. “Don’t focus on ADHD symptoms because the ADHD symptoms are present,” says Barkley, referring to the ADHD triad of inattention, hyperactivity and impulsiveness — all of which emerge when a person with bipolar disorder has a manic episode. “Instead, focus on emotional and social symptoms of manic episodes.” These symptoms, which are unique to bipolar disorder, include elation, grandiosity, sleeplessness and an extremely positive mood state, followed by a crash during which the person is irritable, depressed, withdrawn and explosive for hours or days.

The age of onset also determines the diagnosis, since symptoms of bipolar disorder usually emerge when a person is in late adolescence or early adulthood, while ADHD’s onset is in childhood. That said, there’s a significant overlap of the two. A 2003 study at Massachusetts General Hospital of 51 adult ADHD patients found that 24 of the patients also had bipolar disorder. According to Barkley, the earlier the onset of bipolar disorder, the more likely that it will be accompanied by ADHD: “If bipolar disorder starts in adulthood, only 20 to 25 percent of people will have ADHD with it,” says Barkley. “If the bipolar disorder starts during teenage years, 45 to 50 percent have ADHD along with that bipolar disorder. And if your bipolar starts in childhood, 80 to 97 percent of those cases will have ADHD with it.”

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