Editing Attention deficit hyperactivity disorder (section)

===Differential diagnosis===
{| class="wikitable floatright" style="width:40em; border:solid 1px #999;"
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|+ Symptoms related to other disorders<ref name="BBDADHD">{{Cite journal |author1=Consumer Reports |author1-link=Consumer Reports |author2=Drug Effectiveness Review Project |author2-link=Drug Effectiveness Review Project |date=March 2012 |title=Evaluating Prescription Drugs Used to Treat: Attention Deficit Hyperactivity Disorder (ADHD) Comparing Effectiveness, Safety, and Price |journal=Best Buy Drugs |page=2 |url=http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/ADHDFinal.pdf |access-date=12 April 2013 |url-status=live |archive-url=https://web.archive.org/web/20121115014628/http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/ADHDFinal.pdf |archive-date=15 November 2012}}</ref>
|-
! width="35%" |Depressive disorder
! width="30%" |Anxiety disorder
! width="35%" |Bipolar disorder
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*feelings of hopelessness, [[low self-esteem]], or unhappiness
*loss of interest in hobbies or regular activities
*[[Fatigue (medical)|fatigue]]
*sleep problems
*difficulty maintaining [[attention]]
*change in [[appetite]]
*[[irritability]] or [[hostility]]
*low tolerance for [[Stress (psychological)|stress]]
*thoughts of death
*unexplained pain
|
*persistent feeling of anxiety
*[[irritability]]
*occasional feelings of [[panic]] or [[fear]]
*[[hypervigilance]]
*inability to pay attention
*tire easily
*low tolerance for [[Stress (psychological)|stress]]
*difficulty maintaining attention
|
'''in manic state'''
*excessive [[happiness]]
*hyperactivity
*[[racing thoughts]]
*[[aggression]]
*excessive talking
*[[grandiose delusions]]
*decreased need for sleep
*inappropriate social behaviour
*difficulty maintaining attention
'''in depressive state'''
*same symptoms as in depression section
|}

The DSM provides [[differential diagnosis|differential diagnoses]] – potential alternate explanations for specific symptoms. Assessment and investigation of clinical history determines which is the most appropriate diagnosis. The DSM-5 suggests [[oppositional defiant disorder]], [[intermittent explosive disorder]], and other disorders such as [[stereotypic movement disorder]] and [[Tourette syndrome]], in addition to specific learning disorder, [[intellectual disability]], [[autism]], [[reactive attachment disorder]], [[anxiety disorder]]s, depressive disorders, [[bipolar disorder]], [[disruptive mood dysregulation disorder]], [[substance use disorder]], [[personality disorder]]s, [[psychotic disorders]], medication-induced symptoms, and [[neurocognitive disorders]]. Many but not all of these are also common comorbidities of ADHD.<ref name="DSM5" /> The DSM-5-TR also suggests [[post-traumatic stress disorder]].<ref name="DSM5TR" />

Symptoms of ADHD that particularly relate to disinhibition and [[irritability]] in addition to low-mood and self-esteem as a result of symptom expression might be confusable with [[dysthymia]] and [[bipolar disorder]] as well as with [[borderline personality disorder]], however they are comorbid at a significantly increased rate relative to the general population.<ref name="Kooij_2010" />{{rp|10|Because adults with ADHD often exhibit low self-esteem, low mood, affective lability and irritability, these symptoms may sometimes be confused with dysthymia, cyclothymia or bipolar disorder and with borderline personality disorder.}} Some symptoms that are viewed superficially due to anxiety disorders, intellectual disability or the effects of substance abuse such as intoxication and [[Drug withdrawal|withdrawal]] can overlap to some extent with ADHD. These disorders can also sometimes occur along with ADHD.

Primary sleep disorders may affect attention and behaviour and the symptoms of ADHD may affect sleep.<ref name="Owens2008">{{cite journal |vauthors=Owens JA |title=Sleep disorders and attention-deficit/hyperactivity disorder |journal=[[Current Psychiatry Reports]] |volume=10 |issue=5 |pages=439–444 |date=October 2008 |pmid=18803919 |doi=10.1007/s11920-008-0070-x |s2cid=23624443}}</ref> It is thus recommended that children with ADHD be regularly assessed for sleep problems.<ref>{{cite journal |vauthors=Walters AS, Silvestri R, Zucconi M, Chandrashekariah R, Konofal E |title=Review of the possible relationship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders |journal=[[Journal of Clinical Sleep Medicine]] |volume=4 |issue=6 |pages=591–600 |date=December 2008 |pmid=19110891 |pmc=2603539 |doi=10.5664/jcsm.27356}}</ref> Sleepiness in children may result in symptoms ranging from the classic ones of yawning and rubbing the eyes, to disinhibition and inattention. [[Obstructive sleep apnea]] can also cause ADHD-like symptoms.<ref name="pmid22670023">{{cite journal |vauthors=Lal C, Strange C, Bachman D |title=Neurocognitive impairment in obstructive sleep apnea |journal=[[Chest (journal)|Chest]] |volume=141 |issue=6 |pages=1601–1610 |date=June 2012 |pmid=22670023 |doi=10.1378/chest.11-2214}}</ref>

In general, the DSM-5-TR can help distinguish between many conditions associated with ADHD-like symptoms by the context in which the symptoms arise.<ref name="DSM5TR" /> For example, children with [[Learning disability|learning disabilities]] may feel distractable and agitated when asked to engage in tasks that require the impaired skill (e.g., reading, math), but not in other situations. A person with an [[intellectual disability]] may develop symptoms that overlap with ADHD when placed in a school environment that is inappropriate for their needs. The type of inattention implicated in ADHD, of poor persistence and sustained attention, differs substantially from selective or oriented inattention seen in [[cognitive disengagement syndrome]] (CDS), as well as from rumination, reexperiencing or mind blanking seen in anxiety disorders or PTSD.

In mood disorders, ADHD-like symptoms may be limited to [[Mania|manic]] or depressive states of an episodic nature. Symptoms overlapping with ADHD in [[psychotic disorders]] may be limited to psychotic states. [[Substance use disorder]], some medications, and certain medical conditions may cause symptoms to appear later in life, while ADHD, as a [[neurodevelopmental disorder]], requires for them to have been present since childhood.

Furthermore, a careful understanding of the nature of the symptoms may help establish the difference between ADHD and other disorders.<ref name="DSM5TR" /> For example, the forgetfulness and impulsivity typical of ADHD (e.g., in completing school assignments or following directions) may be distinguished from [[Oppositional defiant disorder|opposition]] when there is no hostility or defiance, although ADHD and ODD are highly comorbid.{{cn|date=April 2025}} Tantrums may differ from the outbursts in [[intermittent explosive disorder]] if there is no aggression involved. The fidgetiness observed in ADHD may be differentiated from [[tic]]s or [[Stereotypy|stereotypies]] common in Tourette syndrome or autism.{{cn|date=April 2025}}

Also, the social difficulties often experienced by individuals with ADHD due to inattention (e.g., being unfocused during the interaction and therefore missing cues or being unaware of one's behavior)<ref>{{Cite book |last1=Barkley |first1=Russell A. |title=Taking charge of adult ADHD: proven strategies to succeed at work, at home, and in relationships |last2=Benton |first2=Christine M. |date=2022 |publisher=[[Guilford Press]] |isbn=978-1-4625-4685-5 |edition=2nd |location=New York London |pages=74–76}}</ref> or impulsivity (blurting things out, asking intrusive questions, interrupting) may be contrasted with the social detachment and deficits in understanding social cues associated with autism. Individuals with ADHD may also present signs of the social impairment or emotional and cognitive dysregulation seen in [[personality disorder]]s, but not necessarily such features as [[Borderline personality disorder|a fear of abandonment, an unstable sense of self]], [[Narcissistic personality disorder|narcissistic tendencies]], [[Antisocial personality disorder|aggressiveness]], or other personality features.<ref name="DSM5TR" />

While it is possible and common for many of these different conditions to be comorbid with ADHD, the symptoms must not be better explained by them, as per diagnostic criterion E in the DSM-5.<ref name="DSM5" /><ref name="DSM5TR" /> The symptoms must arise early in life, appear across multiple environments, and cause significant impairment. Moreover, when some of these conditions are in fact comorbid with ADHD, it is still important to distinguish them, as each may need to be treated separately.<ref>{{Cite book |last1=Barkley |first1=Russell A. |title=Taking charge of adult ADHD: proven strategies to succeed at work, at home, and in relationships |last2=Benton |first2=Christine M. |date=2022 |publisher=[[Guilford Press]] |isbn=978-1-4625-4685-5 |edition=2nd |location=New York London |chapter=Other Mental and Emotional Problems}}</ref>