ADHD Misdiagnosis: Signs, Impact & Next Steps to Take

Why Is ADHD Misdiagnosed?

Attention-deficit/hyperactivity disorder (ADHD) is frequently misdiagnosed due to its overlapping symptoms with other conditions, like anxiety and depression. Additionally, inattention and hyperactivity can be mistakenly viewed as normal childhood behavior. Lack of awareness about ADHD, especially in adults and females, contributes to misdiagnosis. Furthermore, there’s a tendency to rely on subjective reports rather than on comprehensive evaluations.

Factors that contribute to an ADHD misdiagnosis include:

Age

A child’s age can significantly influence the likelihood of childhood ADHD misdiagnosis. Young children often display behaviors that overlap with ADHD symptoms, such as inattention, hyperactivity, and impulsivity, which are typical developmental stages. Overdiagnosis in young children can result in unnecessary treatment, while underdiagnosis may lead to a lack of needed support.²

In adults, age can also be a factor in adult ADHD misdiagnosis. Some adults may have undiagnosed ADHD from childhood; their symptoms can persist or evolve. Adult ADHD symptoms may manifest differently from those in children and can be attributed to other conditions, like anxiety, depression, or stress.

Gender

Gender plays a role in the misdiagnosis of ADHD in children. Boys are more commonly diagnosed with ADHD than girls due to differences in symptom presentation. Adolescent and teen boys with ADHD often display more noticeable externalizing behaviors like hyperactivity and impulsivity, making them easier to identify. Conversely, girls with ADHD may exhibit more internalizing symptoms, such as inattention and maladaptive daydreaming, which can be overlooked or misinterpreted as other issues like anxiety or learning disabilities.²

In adults, gender can also influence ADHD misdiagnosis. Women with ADHD may present with inattentiveness, disorganization, and emotional dysregulation, which can be mistakenly attributed to mood disorders or other conditions. In contrast, men with ADHD may exhibit more overt hyperactivity and ADHD-induced impulsivity. This gender-based symptom variation can result in underdiagnosis or misdiagnosis in both men and women.

Diagnostic Criteria

The diagnostic criteria for ADHD can be quite rigid, requiring a specific number of symptoms in different areas. However, children may exhibit various behaviors and symptoms that don’t neatly fit these criteria. Some children may display intermittent or situational symptoms that do not consistently meet the required threshold for an ADHD diagnosis, leading to potential underdiagnosis. Others may exhibit symptoms that overlap with other developmental or emotional issues, making it challenging to distinguish between ADHD and other conditions.

In adults, the diagnostic criteria for ADHD can also pose challenges. The criteria were initially designed for children and needed to fully capture the range of symptoms and presentations seen in adults. Adult ADHD symptoms can be more subtle, with inattentiveness, disorganization, and difficulties with time management being more prominent than hyperactivity.

Symptom Overlap

In children, symptom overlap is a common contributor to ADHD misdiagnosis. Many behaviors associated with ADHD, such as inattention, impulsivity, and hyperactivity, can resemble typical childhood behaviors. For instance, a child’s difficulty paying attention in class may be attributed to a short attention span or a difficult home life, not necessarily ADHD. Similarly, hyperactivity in children can be misattributed to youthful energy.

In adults, symptom overlap with other mental health conditions like anxiety, depression, or stress is a common factor contributing to misdiagnosis. For example, difficulties with concentration or impulsivity can be associated with various emotional or cognitive disorders. Adults with undiagnosed or untreated mood disorders may exhibit ADHD-like symptoms, leading to an incorrect diagnosis of adult ADHD.³

Lack of Awareness

In children, a lack of awareness by professionals about ADHD can lead to misdiagnosis. Teachers and parents may not recognize the symptoms, mistaking ADHD for laziness, disobedience, or academic difficulties. Consequently, children with ADHD may not receive early intervention or appropriate support, potentially leading to underdiagnosis.

In adults, a lack of awareness about ADHD can also result in underdiagnosis or misdiagnosis. Many adults with ADHD symptoms may not be aware of the condition because it often goes undiagnosed in childhood. Symptoms like chronic disorganization, inattention, and impulsivity can be mistakenly attributed to personal shortcomings rather than an underlying condition.

Inadequate Assessment

In children, quick evaluations, such as relying solely on the teacher or parental reports, may not comprehensively understand a child’s behavior. ADHD symptoms can be subtle and vary in different settings. Inadequate assessment may result in an inaccurate diagnosis, leading to the prescription of unnecessary medications or a lack of necessary support services.

Similarly, in adults, Adult ADHD symptoms can be mistaken for common stress-related or mood disorder symptoms. Without a comprehensive evaluation by a qualified mental health professional, individuals may receive an incorrect diagnosis, potentially leading to ineffective treatment. Proper assessment should consider the individual’s developmental history, daily functioning, and other coexisting conditions to diagnose ADHD in adults accurately.

Developmental Differences

Developmental differences play a significant role in ADHD misdiagnosis in children. The rate at which children mature can vary widely, and what is considered normal behavior can change as they grow. For example, a preschooler’s hyperactivity might be entirely age-appropriate, but if this behavior persists into later childhood, it could indicate ADHD. Misdiagnosis can occur when healthcare professionals and parents fail to account for these developmental variations.

In adults, the misinterpretation of ADHD symptoms can also be influenced by developmental differences. Some individuals may have undiagnosed ADHD from childhood, and their symptoms might evolve or become more subtle as they age. Adults may display more internalized symptoms, such as chronic disorganization or restlessness, which can be misattributed to stress or personality traits.

Conditions That Mimic ADHD

Several mental health disorders share symptoms with ADHD, leading to potential misdiagnosis. Anxiety disorders can cause inattention, restlessness, and distractibility. Mood disorders, such as depression, can also lead to concentration difficulties and irritability, mirroring ADHD symptoms, especially in adults. Additionally, conditions like sleep disorders, learning disabilities, and substance abuse can produce symptoms like impulsivity and poor focus, contributing to ADHD misdiagnosis.

Conditions that mimic ADHD that could lead to an ADHD misdiagnosis include:

Bipolar Disorder

Bipolar and ADHD share overlapping symptoms like hyperactivity, impulsivity, distractibility, and irritability, making it challenging to distinguish between the two, particularly during a manic phase of bipolar disorder. This similarity can lead to bipolar disorder being misdiagnosed as ADHD, especially in individuals who haven’t experienced a clear depressive episode.

Between bipolar I or bipolar II, Bipolar II is more likely to be misdiagnosed as ADHD because its manic symptoms tend to be less severe and can be mistaken for the hyperactivity and impulsivity seen in ADHD.⁴

Anxiety

Anxiety and ADHD symptoms can overlap, as both conditions may include restlessness, inattention, and difficulty concentrating. This similarity can result in anxiety disorders, especially the Generalized Anxiety Disorder (GAD) type of anxiety, being misdiagnosed as ADHD, particularly in children. The persistent worry and restlessness seen in GAD can be confused with inattention and impulsivity, highlighting the importance of a thorough evaluation to differentiate between the two conditions.

Autism

Autism and ADHD can exhibit overlapping symptoms, including difficulties with social interactions, inattention, and impulsivity. This similarity can occasionally lead to autism spectrum disorder (ASD) being misdiagnosed as ADHD, particularly in children. However, it’s important to consider the broader context and the presence of social communication deficits and repetitive behaviors that are hallmark features of ASD but not typical of ADHD.

Low Blood Sugar Levels

Low blood sugar levels, often associated with conditions like hypoglycemia, can lead to inattention, irritability, and difficulty concentrating, which resemble ADHD symptoms. These similarities can result in low blood sugar levels being misdiagnosed as ADHD, particularly when fleeting episodes of hypoglycemia occur.

Sensory processing disorder

Sensory processing disorder (SPD) and ADHD share common symptoms, including restlessness, distractibility, and difficulty with attention and concentration. These overlapping symptoms can potentially lead to SPD being misdiagnosed as ADHD, particularly in children. However, it’s important to consider the specific sensory sensitivities, over- or under-reactivity to sensory stimuli, and atypical responses to sensory input characteristic of SPD, which are not typical of ADHD.

Insomnia

Insomnia and ADHD symptoms can be similar, as both may result in fatigue, inattention, and difficulty concentrating. This similarity can lead to insomnia being misdiagnosed as ADHD, especially in adults.

Hearing Problems

Hearing problems, such as hearing loss or auditory processing disorders, can lead to symptoms that resemble ADHD, including inattention and distractibility. These overlapping symptoms can result in hearing problems being misdiagnosed as ADHD, particularly in children who struggle with listening, following instructions, and staying engaged in classroom activities.

Signs of ADHD Misdiagnosis

ADHD misdiagnosis has significant consequences, so awareness of potential warning signs is essential. One common sign is a lack of response to ADHD treatments or medications, indicating that the initial diagnosis may not be accurate. Inconsistent symptoms that don’t align with the typical course of ADHD can also suggest misdiagnosis, especially when behavioral issues vary across different settings, such as home and school.

Signs of ADHD Misdiagnosis In Children

One key indicator of an ADHD misdiagnosis in a child is if their symptoms persist or worsen despite adherence to recommended ADHD treatments. Inconsistent symptom presentation across different settings, such as school, home, and social activities, could also point to potential misdiagnosis, as ADHD symptoms typically manifest consistently. It’s also important to consider the possibility of misdiagnosis if a child exhibits symptoms that do not align with their developmental stage.

Impacts of ADHD Misdiagnosis

ADHD misdiagnosis can have profound impacts on individuals. Misdiagnosis may lead to unnecessary medication, stigma, and a lack of appropriate support. In children, it can hinder academic performance and impact self-esteem. In adults, misdiagnosis can lead to unaddressed mental health or cognitive issues and impede an individual’s ability to fulfill their potential and manage daily responsibilities effectively, affecting both personal and professional life.

An ADHD misdiagnosis may impact someone in the following ways:

• Reduced self-esteem: Persistent struggles with symptoms and treatment that don’t address their actual needs can erode their confidence, making it difficult to believe in their abilities and potential for success, ultimately leading to reduced self-esteem.
• Unaddressed underlying conditions: An ADHD misdiagnosis can overlook underlying mental health conditions, causing emotional distress, anxiety, or depression to remain untreated, negatively affecting an individual’s psychological health.
• Unnecessary medication: ADHD misdiagnosis can result in individuals, especially children, being prescribed unnecessary medication. These medications can lead to side effects and potential risks, such as increased heart rate, anxiety, and sleep disturbances, without addressing the underlying issues they may be experiencing.
• Academic struggles: Children with an ADHD misdiagnosis may face difficulties in school due to a lack of appropriate support and treatment. This can lead to poor academic performance, frustration, and reduced self-esteem.
• Ineffective treatment: Misdiagnosed individuals may receive inappropriate medications or interventions, leading to side effects and a lack of symptom improvement, thereby hindering their overall well-being.
• Strained relationships: Adults with misdiagnosed ADHD may struggle with relationship challenges due to untreated symptoms, such as impulsivity or inattention, causing misunderstandings or conflicts in personal and professional interactions.
• Work-related difficulties: Adults with misdiagnosed ADHD may face challenges at work, such as poor time management and organization, which can impede career advancement and job performance.
• Missed opportunities: Misdiagnosis can hinder an individual’s ability to reach their full potential, leading to missed opportunities for personal growth, achievement, and happiness.

How to Prevent Misdiagnosis

Preventing misdiagnosis involves several key steps. A thorough psychiatric evaluation by a qualified mental health professional is instrumental in achieving accurate diagnoses. This evaluation considers the individual’s medical history and symptoms, often including input from family members and other relevant sources.

While brain scans to check for mental illness can provide valuable information about brain function, they are not a primary tool for diagnosing mental illnesses like ADHD. Effective prevention of misdiagnosis relies on comprehensive clinical assessments and open communication between the patient and mental healthcare provider to accurately identify underlying issues.

What to Do if You Think You Have Been Misdiagnosed

Taking proactive steps to address the situation is crucial if you suspect you’ve been misdiagnosed. Start by seeking a second opinion from a different mental health professional or specialist in the relevant field. Openly communicate your concerns and share your medical history, including prior diagnoses and treatments.

Rebuilding trust may take time, but by advocating for yourself and collaborating with a mental healthcare provider who listens and takes your concerns seriously, you can work towards a more accurate diagnosis and a tailored treatment plan. You must actively participate in your healthcare decisions and seek the most appropriate care for your well-being.

Here are six steps you can take if you think you have been misdiagnosed with ADHD:

1. Contact Your Primary Care Provider

Open communication is a vital step when you suspect an ADHD misdiagnosis. It is important because it allows you to express your concerns and collaborate with your healthcare provider in the diagnostic process. Discuss why you believe the diagnosis may be inaccurate, provide a detailed account of your symptoms and their impact on your life, and inquire about potential alternative explanations for your experiences. This dialogue with your healthcare provider can foster trust and ensure your concerns are addressed, potentially leading to a reevaluation or second opinion if needed.

2. Contact a Psychiatrist

Consulting with a psychiatrist is pivotal if you suspect a misdiagnosis of ADHD for several reasons. A psychiatrist can review your medication regimen and make the essential adjustments to put you on the right path. By working with a psychiatrist, you can correct the diagnosis and pave the way for a treatment plan tailored to your actual needs. In addition, psychiatrists can identify any co-occurring conditions or contributing factors that may have led to the misdiagnosis, offering a more comprehensive evaluation of your mental well-being.

3. Get a Second Opinion

Getting a second opinion should be a consideration when you have legitimate concerns about the accuracy of your diagnosis. It may not always be necessary to seek one immediately, but it’s important if you have persistent doubts or if the initial treatment could be more effective. When pursuing a second opinion, you can find a psychiatrist who specializes in adult ADHD or childhood ADHD to conduct a fresh evaluation of your condition.

Ensure the new provider is well-qualified, experienced, and well-known for diagnosing and treating ADHD and related conditions. This second opinion can provide valuable insights and help you make an informed decision about your diagnosis and treatment.

4. Gather Medical Records

Collecting and organizing your medical records is essential when you suspect an ADHD misdiagnosis. It’s important because these records provide valuable information for the healthcare professionals involved in the reevaluation process. Your medical history, prior assessments, test results, and treatment history can help you understand the context of the initial diagnosis and the progression of your symptoms over time.

By presenting these records to the new mental healthcare provider during the second opinion, you ensure they have a comprehensive view of your health, which can significantly aid in achieving an accurate diagnosis and tailored treatment plan.

5. Request Comprehensive Evaluation

A comprehensive evaluation plays a pivotal role in addressing an ADHD misdiagnosis. Delving deeper into an individual’s health profile and considering physical, mental, and emotional aspects helps uncover any underlying conditions that might have been erroneously interpreted as ADHD. This can include conditions like anxiety, depression, or learning disabilities.

The significance of such an evaluation lies in its ability to provide a precise diagnosis, enabling the development of personalized treatment plans. When ADHD is ruled out and another condition correctly identified, the treatment can be tailored to address the underlying issues.

6. Create a New Tailored Treatment Plan

Creating a new treatment plan after an ADHD misdiagnosis ensures that you receive tailored interventions suited to your newly discovered needs, which was lacking under the initial misdiagnosis.  For instance, if anxiety or a learning disability is mistaken for ADHD, appropriate treatments like anxiety-specific medication or educational support can be more effective. Moreover, a new tailored plan minimizes health risks by avoiding unnecessary treatments and medications that may have been prescribed based on misdiagnosis. This significantly reduces the risk of side effects, complications, and adverse reactions associated with treatments unsuitable for the individual’s condition.

Extra Steps to Take If You Think Your Child Has Been Misdiagnosed

If a parent suspects their child has been misdiagnosed with ADHD, they should contact the child’s school to communicate their concerns and collaborate on necessary educational adjustments. It’s essential to work closely with educators to meet the child’s needs. Additionally, consulting with a child psychologist or psychiatrist for a second opinion and comprehensive assessment can provide a clearer understanding of the child’s condition. Collaborating with healthcare professionals, educators, and specialists can help guide the parents toward an accurate diagnosis and an effective plan to support their child’s well-being and academic success.

How to Talk to Your Primary Care Provider About Misdiagnosis

To discuss a potential misdiagnosis with your primary care provider, approach the conversation with respect and a focus on shared decision-making. Start by expressing your concerns and emphasizing your desire for an accurate diagnosis to ensure you receive the appropriate care. Share specific reasons for your doubts, such as persistent symptoms or a lack of improvement with current treatments. Be prepared to ask questions and listen to your healthcare provider’s insights.

Here are some steps you can take to prepare for a conversation with your doctor:

• Keep a diary of your symptoms: Track your symptoms’ frequency, duration, and severity, enabling you and your healthcare provider to identify patterns and changes. You should note the date and time of each symptom, a description of the symptom, its impact on your daily life, any potential triggers, and your response to treatments or interventions.
• Document your concerns: Write down specific reasons why you believe the initial diagnosis is incorrect, such as persistent or inconsistent symptoms. This documentation will help you articulate your concerns during the conversation.
• Gather information: Before the conversation, gather all relevant medical records, past diagnoses, and treatment history. This will give your primary care provider a comprehensive health and symptoms overview.
• Consider bringing a loved one: When deciding who to bring, consider someone familiar with your health concerns who can advocate for your well-being. It could be a family member, a close friend, or a trusted individual who can actively participate in the conversation and provide valuable input.
• Ask for your medical records: Contact your healthcare provider’s office and ask for a copy of your records. They may have a specific request process involving completing a form or sending a written request. Once you receive your records, review them carefully and share them with any healthcare providers involved in your care to ensure an accurate diagnosis and treatment.
• Communicate assertively: Assertive communication involves expressing your thoughts, concerns, and doubts respectfully and confidently. Being assertive means speaking up about your concerns while actively listening to your healthcare provider’s perspective and working together to meet your health needs.
• Ask questions: Prepare a list of questions to ask your healthcare provider. These may include inquiring about the possibility of a second opinion or further evaluation to confirm or rule out a misdiagnosis.
• Stay open-minded: Approach the conversation with an open mind and a willingness to collaborate. While expressing your concerns, be receptive to your primary care provider’s insights and recommendations.

How to Handle ADHD Medication When Misdiagnosed

If you suspect you’ve been misdiagnosed with ADHD and are currently taking ADHD medication such as Adderall, it’s essential not to discontinue it abruptly. Going off the medication cold turkey can lead to withdrawal symptoms and potential health risks. Instead, contact your healthcare provider or psychiatrist to discuss your concerns and explore a gradual tapering plan if discontinuing the medication is deemed appropriate.

An online psychiatrist service can be a valuable resource, offering remote consultations with licensed psychiatrists who can provide guidance, recommendations, and tailored strategies for safely adjusting or discontinuing ADHD medication in the context of a misdiagnosis. They can also facilitate a second opinion or further evaluations to ensure an accurate diagnosis and appropriate treatment.

How to Emotionally Cope After an ADHD Misdiagnosis

Coping with the emotional fallout of an ADHD misdiagnosis can be challenging. Acknowledging and validating your feelings is essential. Seek support from friends and family who can provide a safe space to express and process your emotions. Moreover, focus on self-compassion, recognizing that a misdiagnosis is not your fault. Recognizing you have been misdiagnosed is the first step to receiving appropriate treatment.

Speaking to a therapist is important because they can offer professional guidance and support in processing the complex emotions that can arise from an ADHD misdiagnosis. This process often involves one-on-one sessions where you can openly discuss your feelings, fears, and challenges. A therapist can help you develop coping strategies, provide emotional validation, and assist you in navigating the journey toward accurate diagnosis and appropriate treatment, ultimately promoting emotional healing and well-being.

Here are some tips for how to emotionally cope after an ADHD misdiagnosis:

• Allow yourself to grieve: This might entail mourning the time, opportunities, or experiences affected by the misdiagnosis and the accompanying treatment. This process can involve acknowledging your disappointment, frustration, and sadness and providing yourself with the space and time to process these emotions.
• Seek support: Connect with friends, family, or a therapist who can offer understanding and a safe space to discuss your emotions and challenges. Talking about your experience can be therapeutic.
• Acknowledge your feelings: Recognize and validate your emotions, whether anger, frustration, sadness, or fear. Accepting and expressing these feelings is crucial to start the healing process.
• Utilize mindfulness and relaxation techniques: Practice mindfulness, meditation, or relaxation exercises to manage anxiety and stress. These techniques can help you regain emotional balance and resilience.
• Practice self-compassion: Be kind and forgiving to yourself. Understand that a misdiagnosis is not your fault, and use it as an opportunity for self-discovery and personal growth.
• Educate yourself: Learn more about your actual condition and treatment options. Psychoeducation empowers you to make informed decisions and regain a sense of control.
• Set realistic goals: Adjust your expectations and set realistic goals for your well-being. Focus on gradual improvements and self-care as you work toward accurate diagnosis and effective treatment.
• Connect with support groups: Join support groups or online communities for individuals who have experienced misdiagnoses. Sharing your story and hearing from others can provide valuable insights and a sense of camaraderie.

When to Seek Professional Support

Individuals should seek professional support if they experience persistent negative outcomes resulting from a misdiagnosis, such as emotional distress, impaired daily functioning, or a decline in overall well-being. These issues can include feelings of anxiety, depression, frustration, or confusion.

An online therapist directory is a valuable resource for finding a qualified therapist who addresses such challenges. Online therapy platforms offer convenience, accessibility, and a range of therapeutic options, making it easier for individuals to connect with a therapist who can provide guidance, emotional support, and personalized strategies to cope with the emotional and practical consequences of a misdiagnosis. These platforms offer flexible scheduling and a safe, confidential space for individuals to discuss their experiences and work toward emotional healing and improved mental health.