I’m concerned that my 8-year-old may have been misdiagnosed with ADHD. How can I know for sure, and what should I do next?
Before I get into the answer, I just want to say how great it is that you’re following your instincts and looking into your child’s diagnosis of ADHD (also known as ADD). It’s very important to pay attention to those feelings and get more information.
So what can you do if you’re questioning your child’s diagnosis? The very first thing is to contact the doctor who made the diagnosis. It’s always OK to ask for more information from this person.
The two main areas you’ll likely want to ask about are what information went into making the diagnosis and how your child has been responding to ADHD treatment.
When discussing the diagnosis process, ask if the doctor:
Knew the important details of your child’s development. Details about when your child reached developmental milestones involving behavior and emotional regulation are especially important for an accurate diagnosis.
Requested that you and your child’s teachers fill out ratings scales. These help the doctor base the diagnosis on quantifiable data.
Gathered enough detail on how long your child has been experiencing specific symptoms.
To be diagnosed with ADHD, a child needs to have had a certain number of symptoms for the past six months or longer. These symptoms also need to affect your child’s ability to function in more than one setting. For example, is your child struggling consistently with ADHD symptoms both at home and in school?
Speaking of symptoms, another big area to ask about is how confident the doctor is that your child is showing signs of ADHD and not of something else. There are several issues that often co-occur with ADHD. But they can also occur on their own and be misdiagnosed as ADHD.
For example, ADHD isn’t the only issue that can make it hard for kids to stay focused. What causes that symptom — and how to treat it — may be very different. Here are some issues that could affect the accuracy of your child’s ADHD diagnosis:
Sleep issues: ADHD can affect sleep, but issues like sleep apnea can make kids behave in ways that look a lot like ADHD. Did the doctor ask about things like whether your child snores loudly or wakes up throughout the night?
Anxiety: Kids with anxiety may seem tuned out or preoccupied because they’re distracted by worries. Kids with ADHD can be distracted by anything — including happy thoughts like an upcoming birthday party.
Depression: Kids with depression often have little energy and lose interest in socializing. Kids with ADHD may have mood swings and struggle to get along with peers, but they still crave the chance to socialize.
Learning differences: Sometimes it can be hard to tell why a child is struggling academically. Is it because of trouble staying focused? Or because the child struggles with reading or other skills needed to complete certain tasks?
Trauma or chronic stress: Trauma, such as abuse, neglect, and other childhood experiences, can lead to behavior that looks a lot like ADHD. Chronic stress can also be a consequence of not getting enough support for ADHD and other issues.
Immaturity: Studies have shown that the youngest kids in a grade are more likely to be diagnosed with ADHD. This doesn’t mean these kids don’t have ADHD. But when the doctor and teacher[s] are assessing your child’s behavior, it’s important to take into account whether your child is one of the youngest kids in the grade.
To be clear, ADHD is real. And although the factors I’ve listed above can affect an accurate diagnosis, they can also accompany an accurate diagnosis. It’s very common for ADHD and other issues to co-occur.
These are some of the many things that go into an effective evaluation for ADHD. It takes more than a quick visit with a professional to do a thorough job. A proper evaluation can’t be done in a one-time, 20-minute appointment.
Likewise, finding the right treatments for ADHD can take time too. You may be wondering about misdiagnosis because you’ve tried treatments like ADHD medication and behavior therapy and they haven’t worked.
This could be because ADHD is not the right diagnosis for your child. But it could also be that your child hasn’t been doing behavior therapy for long enough to make a big difference. Or that you and your child’s doctor haven’t found the right ADHD medication or the right dosage yet.
Have you tried using an ADHD medication log? It can help guide conversation with your doctor about whether your child’s treatment plan needs to be adjusted.
What if you’ve discussed all of these issues at length with your doctor and you still have questions? Getting a second opinion is a good idea.
You may want to look into getting a comprehensive neuropsychological evaluation. This kind of evaluation looks at many different areas of functioning, not just attention. It can help determine whether things like anxiety, depression and/or a learning difference might be present.
No matter why you’re questioning your child’s diagnosis, the best remedy is more information. This includes getting information from your child’s teacher. The teacher spends a lot of time with your child in an environment you and the doctor don’t spend much time in.
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About the author
About the author
Ellen Braaten, PhD is the director of LEAP at Massachusetts General Hospital.