Does everyone with attention problems or hyperactivity have ADHD?

No. There are many potential causes for behaviors similar to that seen in ADHD. Children with language disorders who have difficulty understanding and/or expressing themselves can appear inattentive. Their experience may be similar to listening to a foreign language in which words are picked up only here and there. Because they do not always understand what a teacher is saying, such children lose their focus. Consequently, deciding whether a child with language problems also has ADHD can sometimes be difficult. Some children with specific medical problems may also appear to be inattentive. For example, thyroid problems can cause attention difficulties. On the one hand, too little thyroid hormone may cause a child to become inattentive; on the other, too much thyroid hormone may cause hyperactivity. Children with seizures may appear inattentive, but this usually occurs irregularly and only when the seizures are occurring. Children with sleep problems may also appear inattentive because they are so tired during the day. A child with any one of a variety of emotional difficulties may also appear unable to concentrate or may become hyperactive. Children with anxiety or depression sometimes appear preoccupied or distracted. In addition, unlike adults, depressed children may become quite agitated or restless, which can be mistaken for hyperactivity.

As a rule, children with ADHD tend to be distracted by outside stimuli. In contrast, a child with obsessive compulsive disorder or a psychotic illness, for example, may be distracted by internal events, recurring thoughts, and excessive worry. However, a casual observer cannot always tell the difference by the child’s behavior, so it is difficult to correctly identify the source of the problem without careful assessment.

Inattentiveness and hyperactivity also can be side effects of medications. This is particularly common with some of the medications used for treating asthma, particularly theophylline and steroids. Antiseizure medicines can also interfere with attention.

In short, attention problems and hyperactivity are not automatically signs of ADHD, so you should not assume your child has ADHD because you see these behaviors. The child should be assessed by a professional trained to recognize the origins of behavioral problems so that the real cause or causes can be determined.