Attention Deficit Hyperactivity Disorder, or ADHD, has entered the vocabulary of much of the western world. Celebrities, politicians, your neighbors down the street all have people who proclaim they have ADHD. ADHD is technically a neurodevelopmental disorder which affects a person’s capacity to stay focused, pay attention, and inhibit impulsive behaviors. While it can be different in different people, all people with ADHD have problems efficiently processing and retaining information. Being a neurodevelopmental disorder implies that the brain and or the brain chemistry of people with ADHD is somehow different from people who don’t have ADHD. Since we don’t have tests sensitive enough to measure these brain or brain chemistry differences, the diagnosis of ADHD depends on the systematic examination of a person’s behavior. From that, doctors decide some people have ADHD and some people do not.

The diagnostic evaluation of ADHD takes many forms. It ranges from a consultation with a family doctor or pediatrician who takes a history and may give a behavior rating scale to a $3000 comprehensive neuropsychological examination. Whatever the diagnostic method, there is a pivotal question: Are all attentional problems ADHD? Could it be something else?

The short answer to that question is a definite yes, it could be something else. In both adults and children, attentional problems can be a symptom of other conditions. These “other” conditions are most commonly found in mood disorders and/or behavior disorders. Family or school related stresses can activate attentional problems in children. Children with vision problems or sensory processing problems can develop attentional problems secondary to those conditions. In less common situations, attentional problems can be related to underlying medical conditions such as hormonal imbalances, high levels of environmental toxins and recreational drug use. More rarely yet, attentional problems can be related to other underlying neurological conditions such as post-COVID encephalopathy.

The lesson learned is that no case of attentional problems is a simple yes/no diagnosis. Careful history taking, screening for co-existing conditions, and understanding of the person as a whole are important elements to the diagnosis of ADHD.

Dr. Bloom can be reached for ADHD related consultations at drbloom@startmywellness.com