There are some instances when the signs and symptoms of learning disabilities are often mistaken for ADHD in children. As educators and administrators, there are behaviors and symptoms you should be aware to look for in students that have been diagnosed with ADHD. As such, we are going to be taking a look at such things as Nonverbal Learning Disorders (NLD), Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), inattention, repetitive distressing thoughts, restricted speech, sadness, fatigue and difficulties thinking clearly… elements that coexist or otherwise cross the ADHD boundaries for diagnosis.
What is Nonverbal Learning Disorder?
Nonverbal Learning Disorder is a combination of brain-based difficulties that was once considered rare, though now is thought to be as prevalent as dyslexia. Powerfully genetic in origin, NLD affects girls as frequently as it does boys, characterized by poor organizational, spatial and visual abilities; poor motor performance and difficulty recognizing and ultimately processing nonverbal cues – facial expressions, body language, the nuances of a conversation, et al. Many kids thought to have NLD appear to boast large vocabularies, outstanding memory and auditory retention and average-to-superior intellect – and they’re also often misdiagnosed with ADHD (Attention Deficit Hyperactivity Disorder).
Into this foray have come experts such as Marcia Rubinstein, an education specialist based in Hartford, Connecticut and founder of the Nonverbal Learning Disability Association who have understood the reasons behind these misdiagnoses. As she herself puts it, “Virtually every child I’ve seen with NLD was first diagnosed with ADHD. The fact is, pediatricians should be able to recognize NLD and refer children for an evaluation, but teachers and medical professionals are more aware of language-based learning disabilities. This is precisely why I believe every parent of a child with NLD must become a full-time advocate for that child.”
At first glance, children with NLD appear to behave like those with ADHD, yet the appropriate interventions are not the same – a child with NLD may have difficulty sitting still and may bump into people, but this isn’t due to hyperactivity…it’s to be blamed more on poor balance and coordination in addition to difficulty with visuospatial relationships. Indeed, some children exhibit both ADHD and NLD, as explained by Ruth Nass, MD, professor of Pediatric Neurology at New York University School of Medicine: “One can miss the signs of NLD in children with ADHD if there isn’t a thorough neuropsych evaluation.”
Many medical professionals studying relationships between ADHD and “similar looking” issues often make the analogy of headaches – that is, a simple headache can come from a myriad of sources, and without a thorough assessment and exam, it would be absurd for a doctor to diagnose someone with a brain tumor or the flu just because both of these can cause headaches… and, of course, the treatment for a brain tumor and the flu virus would be very, very different. The same thing happens when studying mental illness: That is, many common symptoms show themselves for a variety of reasons, but can reflect a range of different diagnoses.
It is critical to understand what is actually behind a given behavior because, as it is in medicine, the diagnosis a child receives can dramatically alter the appropriate treatment. Here’s a good example: ADHD medications won’t be effective if a child’s inattention or disruptive behavior is sparked by anxiety, not ADHD. And, much like a medical professional, when a treatment doesn’t work – therapeutically or pharmaceutically – one of the things a good clinician will do is reexamine the diagnosis.
How Inattention is Commonly Misdiagnosed as ADHD
In a classroom environment, the symptom of inattention is often first observed by the teacher, who may note an unusually over-distracted student who is prone to daydreaming and has difficulty completing homework assignments… and even following simple directions. While it is true that all children, especially the very young ones, tend to exhibit shorter attention spans than adults, some kids have a much harder time focusing than others… and that makes a case for comparison.
One of the three key symptoms of ADHD, along with impulsivity and hyperactivity, is inattention outside the “typical” range. So, when a child exhibits unusually distracted traits, ADHD tends to be the first thing clinicians and parents suspect. In reality, there are many other possibilities that can be yielding this severe inattention – the child is inattentive perhaps because he or she is worried about a grandparent sick in the hospital, or because he or she is being bullied on the playground and the next period is recess, where the bullying will manifest all over again.
The OCD and PTSD Factors
Many children with Obsessive-Compulsive Disorder (OCD) find themselves distracted by their obsessions and compulsions, but while OCD is severe enough of a problem, it can become quite concerning when they spend the majority of their day obsessing. This can interfere with their lives in a myriad of ways, up to and including paying attention in school; as such, kids with OCD are often ashamed of their symptoms, going to great lengths to hide their compulsions. This is precisely why a teacher may notice a student exhibiting difficulty focusing, immediately assuming he or she has an attention problem – since the OCD is not readily apparent to the teacher.
Many of the symptoms of Post-Traumatic Stress Disorder (PTSD) also look like ADHD, including difficulty concentrating, exaggerated startle response and hypervigilance, and can make it seem as though a child is “jumpy and spacey.” Entities such as the Trauma Response and Education Service at the Child Mind Institute believe children can also appear to be suffering from a form of inattention when they have been impacted by a trauma.
Children with ADHD, specifically those who experience impulsivity and hyperactivity, may exhibit a host of symptoms that make them appear oppositional; they may have difficulty sitting still, they may touch and play with anything around them they can get their hands on, they may blurt out inappropriate remarks, the may have difficulty waiting their turn or constantly interrupt others and act without thinking about any consequences…this almost infinite range of symptoms is more a result of their impaired executive functioning skills (their ability to think ahead and assess the impact of their behaviors) than purposeful oppositional behavior.
Repetitive Distressing Thoughts
Another common lookalike symptom of ADHD is the exhibition of intrusive thoughts and memories, specifically those a child can’t control. This can take place in the form of flashbacks, thinking about an event over and over or experiencing frightening thoughts that simply “get stuck” – but these are, in reality, more of key symptoms pointing to PSTD. Clinicians tend to think of PSTD as a “damaged fight or flight” response in a child who has experienced a disturbing aspect of life – an upsetting event or pattern of domestic violence/abuse.
Selective mutism and autism are the two conditions more appropriately associated with restricted speech, even though ADHD symptoms may mimic these illnesses. Autism is a developmental disorder that leads to a child exhibiting impairments in communication, resulting in a delay (or complete lack of) development of a spoken language, with the most obvious signs of autism noticed around two to three years of age in children. In a school environment, this may first be noticed by education professionals who are alerted to the fact that the child is not interacting socially with his or her peers in an appropriate fashion.
Selective mutism, meanwhile, causes children to display symptoms that may lead to alarm bells ringing for an indication of autism or even ADHD. Some kids with selective mutism appear very “shut down” in approach, but he or she is not going to come across as a kid whose only issue is being “stuck” in terms of being able to talk.
It is quite simple for most people to recognize the symptoms of depression – from feelings of sadness and decreased interest in normally pleasurable hobbies and activities to fatigue, weight changes and difficulty concentrating. And while it is normal for all of us to feel “down in the dumps” at times, children experiencing sadness or irritability which lasts in excess of two weeks and which impairs their ability to function could be experiencing a “depressive episode,” not necessarily ADHD.