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ADHD and Conditions That Mimic ADHD

It is usually fairly easy for classroom teachers to distinguish the students who are on-task from those who are not. Those on-task students tend to be those who are using their time productively towards completing assigned work. These students tend to listen closely to teacher instructions so they may be able to accurately complete the assignment. Generally, on-task students work quietly and purposely during the allotted independent seat work time. However, there are usually a small number of students in the same classroom who tend to be off-task a majority of the time. These students may be quietly avoiding work completion, or they may be actively pursuing other interests in a manner that is disruptive and noticeable. Regardless of the nature of off-task behavior, these students are showing some amount of inattention and under performance in the classroom.
Although a few of these off-task students may have a genuine impairment observed as ADHD, many other students may struggle with inattention due to other reasons. These latter students show ADHD-like symptom as a result of alternative conditions which can effectively interfere with classroom learning.
The most common disruptor to learning in the classroom is low motivation, weak work-study skills, poor organization, and inefficiency of time usage. These students tend to be average to low academic performers who will consistently have difficulty producing a volume of high quality work. Fortunately, their work efforts will improve with additional monitoring and reinforcement offered by the classroom teacher.
Aside from these less efficient and under motivated students, there are usually a smaller number of students who are purposely avoiding work completion. The inattention and off-task behavior of these students easily mimics the core symptoms of ADHD. These students are often targeted for ADHD evaluations due their under performance in the classroom. There are number of alternative conditions that can demonstrate with ADHD like symptoms. These include mental health disruptions resulting from divorce, child abuse, death and loss, family moves, parent unavailability due to occupational travel, sudden traumatic experience, or even dysfunctional parenting. Although these disruptors generally tend to be temporary in a child's life, they can still introduce high amounts of stress that can easily disrupt attention and learning in the classroom.
In addition to these emotional disruptions, there are other mental health conditions that can occur in addition to ADHD, or perhaps be mistaken for ADHD. These conditions are outlined by Mary Fowler in a publication of the National Dissemination Center for Children with Disabilities (April, 2002):
Oppositional Defiant Disorder (ODD) - A pattern of negative, hostile, and defiant behavior. Symptoms include frequent loss of temper, arguing (especially with adults), refusal to obey rules, intentionally annoying others, blaming others. The person is angry, resentful, possibly spiteful, and touchy. (Many of these symptoms disappear with AD/HD treatments.)
Conduct Disorder (CD) - A pattern of behavior that persistently violates the basic rights of others or society's rules. Behaviors may include aggression toward people and animals, destruction of property, deceitfulness or theft, or serious rule violations.
Anxiety - Excessive worry that occurs frequently and is difficult to control. Symptoms include feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
Depression - A condition marked by trouble concentrating, sleeping, and feelings of dejection and guilt. There are many types of depression. With AD/HD you might commonly see dysthymia, which consists of a depressed mood for many days, over or under eating, sleeping too much or too little, low energy, low self-esteem, poor concentration, and feeling hopeless. Other forms of depression may also be present.
Learning Disabilities - Problems with reading, writing, or mathematics. When given standardized tests, the student's ability or intelligence is substantially higher than his or her achievement. Underachievement is generally considered age-inappropriate. [Note: Children with AD/HD frequently have problems with reading fluency and mathematical calculations. AD/HD learning problems have to do with attention, memory and executive function difficulties rather than dyslexia, dysgraphia, or dyscalculia, which are learning disabilities.]
Fowler goes on to describe ADHD as still the most commonly diagnosed behavior disorder of childhood. The core symptoms must reflect inattention, hyperactivity, and impulsivity that consistently disrupt one or more life areas and are developmentally inappropriate when compared to the chronological age of the child. To successfully evaluate, a professional must examine the number of symptoms present, the severity of symptoms, and the extent of the disruption evident in two or more critical life areas. In essence, the professional diagnostician must attempt a comprehensive assessment that evaluates the child globally. In so doing, the alternative diagnostic conditions can be differentiated from a true presentation of ADHD.
By George Gallegos, Ph.D. 
George Gallegos is a licensed clinical psychologist practicing in the Sate of Colorado. He has maintained a private practice for over twenty five years during which time he has developed a long developing expertise with ADHD children. His current work with ADHD assessment and identification is conducted cooperatively with a large pediatric practice. Dr. Gallegos has more recently developed a 78-item test for ADHD entitled the ADHD Pre-Diagnostic Assessment (PDA). The PDA is an ADHD test for parents to use when initial concerns arise about their child. The PDA is intended as a primer measure when considering the possible need for a professional evaluation. The PDA can be used to discriminate essential factors that are predictive of ADHD or alternate conditions that interfere with classroom performance including learning disabilities, sensory integration dysfunction, developmental delays, or emotional/behavioral problems.



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