22 September 2016

How to know if your child is misdiagnosed with ADHD

There's been a 43% increase in the number of US children diagnosed with ADHD – but are all these children really suffering from the disorder?

Children who are struggling with concentration and are hyperactive are often seen as “problem children”. More often than not, they are diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and prescribed medication to stop their “disruptive behaviour” in class.

And according to researchers from the George Washington University Milken Institute School of Public Health there was a 43% increase in ADHD diagnoses among US school pupils in the past decade.

But parents often wonder if this increase is due to the disorder being more prevalent, or due to experts making the diagnosis too early or even unnecessarily?

Read: Memory training helps kids with ADHD

‘Often misdiagnosed’

Dr Renata Schoeman, a specialist psychiatrist, says ADHD is often misdiagnosed. “When a child is restless in the classroom or they daydream, it’s easy to assume it’s ADHD,” she told Health24.

“But just because a child has concentration problems, doesn’t automatically mean they suffer from ADHD.”

Peter Collis, a clinical psychologist from Cape Town, agrees with Schoeman. “ADHD is commonly attributed to disorders of anxiety and depression. Occasionally, it’s associated with bipolar disorder.” This co-morbidity can make diagnosis difficult.

“In adults a similar pattern is present and in a lot of cases ‘ADHD’ is simply an indication of an underlying psychiatric disorder,” says Schoeman.

Comprehensive assessment

There are many symptoms associated with ADHD, some which include:

  • Having a short attention span and being easily distracted
  • Being unable to stick at tasks that are tedious or time-consuming
  • Appearing to be unable to listen to or carry out instructions
  • Not being able to sit still, especially in calm or quiet surroundings
  • Constantly fidgeting
  • Not being able to hold a train of thought in a conversation

Read: Does my child have ADHD?

These are just general symptoms, and Schoeman says a comprehensive assessment is the only way to make sure the diagnosis of ADHD is valid. This is a scientific process and should include:

  • A hearing test. It might be that the child has hearing problems, and thus appear to not be able to concentrate.
  • An eye test. Having visual disturbances can lead to a wrong diagnosis.
  • Occupational assessment. An occupation therapist can determine whether an ADHD component might be present.
  • A lifestyle audit. According to Collis sleeping problems and other lifestyle complications can manifest as ADHD symptoms.
  • A behavioural and emotional assessment. “Sometimes children just need some time to adjust and mature. Or sometimes children have anxiety and other disorders that manifest as ADHD.” A psychologist or psychiatrist can help with this diagnosis.

Schoeman’s advice is to start with so-called “conservative therapy”. “First focus on the environment and see what structure and routine you can provide. Then, if indicated, or in severe cases, medication should be used.”

Signs of a misdiagnosis

Collis says a misdiagnosis would mean that the problem persists: “Despite interventions such as remedial tuition, occupational therapy or psychotherapy, there’s no improvement,” says Collis.

Schoeman agrees and adds that continuous side effects of medication, or the patient not being responsive to the medication, may be indications that one is barking up the wrong tree.

“One always has to weigh up the benefit and risk profile of the patient. If the risks and side effects outweigh the benefits, it might not be worth it.”

Read more:

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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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