Challenges in diagnosing attention-deficit/hyperactivity disorder in pediatric practice: A regional and global perspective

Table 2 Attention-deficit/hyperactivity disorder symptoms vs common mimicking conditions

Attention-deficit/hyperactivity disorder symptom/feature	Possible mimicking conditions	Key differentiating features
Inattention	Learning disabilities (e.g., dyslexia, auditory processing disorder); absence seizures; depression	Learning disabilities often show specific academic skill deficits; absence seizures involve brief staring spells with no awareness; depression may show inattention with low mood and anhedonia
Hyperactivity	Anxiety disorders; ASD; sensory processing disorder	Anxiety often causes fidgeting from internal distress, not impulsivity; ASD may involve repetitive behaviors and poor social reciprocity; sensory issues are context-dependent and linked to specific stimuli
Impulsivity	Bipolar disorder; ODD; normal developmental behavior in preschoolers	Bipolar disorder includes episodic mood elevation and risk-taking; ODD involves deliberate defiance rather than spontaneous impulsivity; preschool impulsivity often improves with age and structure
Difficulty sustaining attention	Sleep disorders (e.g., obstructive sleep apnea, insufficient sleep); trauma and PTSD	Sleep disorders show fatigue, snoring, and poor morning arousal; PTSD may include hypervigilance, intrusive thoughts, and avoidance
Poor academic performance	Intellectual disability; specific learning disorders; environmental neglect	Intellectual disability involves global developmental delay; learning disorders are subject-specific; environmental factors often improve with intervention
Behavioral problems in school	Language disorders; hearing impairment; conduct disorder	Language/hearing issues lead to frustration-based behaviors; conduct disorder involves intentional aggression and rule-breaking

ASD: Autism spectrum disorder; ODD: Oppositional defiant disorder; PTSD: Post-traumatic stress disorder.