Updated 20 September 2019

5 conditions that could be mistaken for ADHD

Many medical professionals are too quick to diagnose ADHD in children, failing to take into account other possible causes of their symptoms.

South Africa has one of the highest rates of prescribing medication for attention deficit hyperactivity disorder (ADHD) – even higher than in the USA.

This raises questions about the prevalence of overdiagnosis or misdiagnosis of ADHD, and if there might not be other reasons why children have learning problems and are difficult to control. 

French child psychiatrists for example prefer a more holistic, psychosocial approach to ADHD-type symptoms and also allow for considering nutritional causes.

A Health24 article points out that there is no single test to diagnose ADHD and that conditions that manifest similar symptoms need to be ruled out before a positive diagnosis can be made.  

Because ADHD diagnosis relies on a process of elimination and can therefore not be 100% conclusive, it's important that you seek a second opinion and/or insist on further tests if you don't agree with a paediatrician's diagnosis.    

Other possible causes

Here are five examples of conditions that can mimic the symptoms of ADHD and may be worth investigating:

1. Stress and anxiety

According to the South African Depression and Anxiety Group (SADAG), South Africans are under extreme amounts of stress and don’t know how to deal with it. Factors like economic uncertainty, high levels of unemployment and high crime levels greatly contribute to our daily stress levels.

When difficulties with concentration appear to be caused by ADHD, a closer look may reveal underlying causes that actually point to stress and anxiety.

2. Lack of exercise

It is well known that physical activity has a positive effect on the body and mind and helps to release energy and tension.

Many children don’t get enough exercise and have pent-up energy that manifests in fits and spurts, like bouncing in a chair while watching TV. Exercise can make people happier, less anxious, less hyperactive, and less depressed.

It's also no secret that most boys are more active and prone to rough behaviour than girls.

3. Hypoglycaemia

Hypoglycaemia, also called low blood sugar, can cause a number of symptoms similar to ADHD including aggression, hyperactivity, inability to sit still or low concentration levels. In addition, low blood sugar can create feelings of hostility and anger. ADHD shares many of these symptoms.

4. Nutritional deficiencies

According to the University of Maryland Medical Center the following deficiencies could mimic some of the symptoms of ADHD:

- Magnesium

Magnesium deficiency symptoms include irritability, decreased attention span and mental confusion. Children with ADHD may have a mild magnesium deficiency.

- Vitamin B6

Vitamin B6 is needed to make brain chemicals like serotonin, dopamine, and norepinephrine – neurotransmitters that may be affected in children with ADHD. Conclusions on whether vitamin B6 improves behaviour among hyperactive vary considerably. One needs to be careful, though, seeing as high doses of B6 can cause nerve damage

- Zinc

Zinc regulates the activity of brain chemicals, fatty acids and melatonin, which are all related to behaviour. It has been shown that zinc may help improve behaviour but, as in the case of vitamin B6, high doses of zinc can be dangerous.

- Essential fatty acids

Fatty acids like omega-3 and -6 fatty acids play a key role in normal brain function. Study results are however mixed. Omega-3 fatty acids are also good for heart health, but high doses may increase the risk of bleeding.

- L-carnitine

L-carnitine is formed from an amino acid and helps cells in the body produce energy. There is some indication that L-carnitine may improve behaviour in children with ADHD, but more research is needed.

5. Learning disabilities

There are many reasons why children may have trouble learning. Examples are dyslexia, hearing or sight problems, social skills issues and intellectual disability (previously called mental retardation).

Undiagnosed learning disorders can make school hard, and children are often called lazy, stupid, and other names that can affect their self-esteem. This may cause them to react in non-productive ways like undisciplined behaviour, bullying or fooling around.

Read more:

Understanding ADHD

ADHD kids have multiple conditions

ADHD drugs hallucinogenic?


Ask the Expert

ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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