Can Any Other Conditions Produce These Symptoms?
The fact is, many things can produce these behaviors.  Anything from
chronic fear to mild seizures can make a child seem overactive,
quarrelsome, impulsive, or inattentive.  For example, a formerly
cooperative child who becomes overactive and easily distracted after
a parent's death is dealing with an emotional problem, not ADHD.  A
chronic middle ear infection can also make a child seem distracted and
uncooperative.  So can living with family members who are physically
abusive or addicted to drugs or alcohol.  Can you imagine a child
trying to focus on a math lesson when his or her safety and well-being
are in danger each day?  Such children are showing the effects of
other problems, not ADHD.
In other children, ADHD-like behaviors may be their response to a
defeating classroom situation.  Perhaps the child has a learning
disability and is not developmentally ready to learn to read and write
at the time these are taught.  Or maybe the work is too hard or too
easy, leaving the child frustrated or bored.
Some children's attention and class participation
improve when the class structure and lessons are adjusted a bit to meet
their emotional needs, instructional level, or learning style.
Although such children need a little help to get on track at school,
they probably don't have ADHD.
It's also important to realize that during certain stages of
development, the majority of children that age tend to be inattentive,
hyperactive, or impulsive--but do not have ADHD.  Preschoolers have
lots of energy and run everywhere they go, but this doesn't mean they
are hyperactive.  And many teenagers go through a phase when they are
messy, disorganized, and reject authority.  It doesn't mean they will
have a lifelong problem controlling their impulses.  ADHD is a serious
diagnosis that may require long-term treatment with counseling and
medication.  So it's important that a doctor first look for and treat
any other causes for these behaviors.
SIDEBAR:  What Can Look Like ADHD?
  --  Underachievement at school due to a learning disability
  --  Attention lapses caused by petit mal seizures
  --  A middle ear infection that causes an intermittent hearing problem
  --  Disruptive or unresponsive behavior due to anxiety or depression
Can Other Disorders Accompany ADHD?
One of the difficulties in diagnosing ADHD is that it is often
accompanied by other problems.  For example, many children with ADHD
also have a specific learning disability (LD), which means they have
trouble mastering language or certain academic skills, typically
reading and math.  ADHD is not in itself a specific learning disability.
But because it can interfere with concentration and attention, ADHD
can make it doubly hard for a child with LD to do well in school.
A very small proportion of people with ADHD have a rare disorder called
Tourette's syndrome.  People with Tourette's have tics and other
movements like eye blinks or facial twitches that they cannot control.
Others may grimace, shrug, sniff, or bark out words.  Fortunately,
these behaviors can be controlled with medication.  Researchers at
NIMH and elsewhere are involved in evaluating the safety and
effectiveness of treatment for people who have both Tourette's
syndrome and ADHD. More serious, nearly half of all children with
ADHD--mostly boys--tend to have another condition, called
oppositional defiant disorder.
These children may overreact or lash out when they feel
bad about themselves.  They may be stubborn, have outbursts of
temper, or act belligerent or defiant.  Sometimes this progresses to
more serious conduct disorders.  Children with this combination of
problems are at risk of getting in trouble at school, and even with
the police.  They may take unsafe risks and break laws--they may
steal, set fires, destroy property, and drive recklessly. It's
important that children with these conditions receive help before the
behaviors lead to more serious problems.
At some point, many children with ADHD-mostly younger children and
boys--experience other emotional disorders.  About one-fourth feel
anxious.  They feel tremendous worry, tension, or uneasiness, even when
there's nothing to fear.  Because the feelings are scarier, stronger,
and more frequent than normal fears, they can affect the child's
thinking and behavior.  Others experience depression.  Depression goes
beyond ordinary sadness--people may feel so "down" that they feel
hopeless and unable to deal with everyday tasks.  Depression can
disrupt sleep, appetite, and the ability to think.
--- PPoint 2.03
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