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Section 2
Diagnosing ADHD Symptoms

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In the last section, we talked about the eight common ADHD symptoms. These eight symptoms are inattention, impulsivity, difficulty delaying gratification, emotional overarousal, hyperactivity, noncompliance, social problems, and disorganization.

In this section... we will be discussing five Idiosyncratic, Unique Patterns of children with ADHD. These patterns may cause the diagnosis to be missed in a genuine ADHD child. These factors include good social skills, a high IQ, shyness, no siblings or one-on-one preschool situation with parents, and ADHD without hyperactivity. In the second part of this section, we will also talk about the misdiagnosis of ADHD for Learning Disabled.

Five Idiosyncratic, Unique Patterns

♦ Pattern #1 - Good Social Skills
The first pattern causing an ADHD child to be misdiagnosed is good social skills. ADHD children with good social skills get along well with their peers. As you are aware, the ADHD symptoms are moderated just enough for the children to become social assets. For example, a child with ADHD may be seen as having leadership abilities instead of bossiness tendencies.

♦ Pattern #2 - High IQ
The second pattern that may cause an ADHD child to be misdiagnosed is a high IQ. For children with ADHD and a high IQ, school is an arena where they can not only succeed but may actually enjoy life. Because the ADHD child with a high IQ receives positive reinforcement from his or her parents and teachers, he or she can often control inappropriate behavior in the academic environment. However, as you can probably guess, once the ADHD child with a high IQ gets home from school, he or she often displays a number of hyperactive symptoms.

♦ Pattern #3 - Shyness
Like the first two patterns of good social skills and a high IQ, the third pattern of shyness can cause a child with ADHD to be missed. While most ADHD children seem uncaring about others and socially boorish, the shy ADHD child will be extremely concerned about others’ opinions. For this reason, like the ADHD child with a high IQ, the shy ADHD child will inhibit their hyperactive behavior in public but show the ADHD symptoms at home.

♦ Pattern #4 - No Siblings or One-on-One Preschool Situations
The fourth pattern that causes an ADHD child to be missed is a lack of siblings or having a one-on-one preschool situation with parents. For these ADHD children, the symptoms of ADHD do not appear until they begin school. The lack of ADHD symptoms is often tied to the lack of competition with siblings. Having reasonably competent and attentive parents can also produce fairly normal behavior for a while. It is not until these ADHD children start school and are introduced to competition that they begin to display ADHD symptoms.

♦ Pattern #5 - ADHD without Hyperactivity
Finally, the fifth pattern that can cause an ADHD child to be missed is ADHD without hyperactivity. Without hyperactivity, many other symptoms of ADHD, like emotional overarousal, are moderated better. However, the child with ADHD but no hyperactivity will still exhibit some symptoms of ADHD. In these cases, as you know, diagnosis must focus on the existence of a major concentrational difficulty. As you know, concentrational difficulty is often displayed through persistent passive noncompliance and disorganization.

♦ Misdiagnosed as Learned Disabled
In addition to the five Idiosyncratic, Unique Patterns that cause ADHD children to be misdiagnosed, there is also the possibility that the child with ADHD will be misdiagnosed as Learning Disabled. While ADHD and LD often overlap, there are children who have one handicap but not the other. I have found that there are four ways to discriminate ADHD from LD.

4 Ways to Discriminate ADHD from LD
--1. The first way to determine if the child has ADHD or LD is to look at his or her developmental history. By age two or three, most LD-only children will not show many ADHD symptoms, such as hyperactivity, impulsivity, or emotional overarousal.
--2. Second, check the child’s IQ. If the IQ and achievement are compatible and the tests are considered valid, LD can often be ruled out. For example, If the IQ is below average and the achievement is below average, the child may simply have LD. However, if the IQ is above average and the achievement is below average, the child may be ADHD.
--3. Third, consider past comments by teachers. If during the early school years the comments were consistently about distractibility and short attention span, the child is likely ADHD-only.
--4. Fourth, a medication trial can often eliminate many ADHD symptoms. If the child with ADHD is medicated and then shows no academic handicaps or underachievement, he or she is likely ADHD-only.

So if they have no handicaps or underachievement, the child is only ADHD as opposed to ADHD with LD. Medication cannot remedy a true learning disability. Do you have any clients who may have been misdiagnosed?

In this section... we talked about the five Idiosyncratic, Unique Patterns of good social skills: a high IQ, shyness, no siblings or one-on-one preschool situation with parents, and ADHD without hyperactivity. We also discussed the misdiagnosis of ADHD for Learning Disabled.

Peer-Reviewed Journal Article References:
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1), 128–138.

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