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

Table 6 Symptom overlap between attention-deficit/hyperactivity disorder and common mimicking/co-occurring conditions

Condition	Overlapping symptoms with attention-deficit/hyperactivity disorder	Distinguishing features
Autism spectrum disorder	Inattention, impulsivity, hyperactivity, social difficulties	Restricted/repetitive behaviors, impaired social communication, sensory sensitivities, poor non-verbal cues, early developmental delays
Anxiety disorders	Restlessness, inattention, fidgeting, irritability	Worry, somatic complaints, symptoms worsen in specific situations, avoidance behavior, sleep disturbance tied to fear
Depression	Poor concentration, low motivation, irritability, social withdrawal	Anhedonia, persistent sadness, low energy, appetite/sleep changes, feelings of worthlessness
Learning disabilities (e.g., dyslexia)	Inattention, academic underachievement, task avoidance	Difficulty in specific academic domains (e.g., reading/spelling/math), performance improves with support, frustration limited to academic tasks
Sleep disorders (e.g., obstructive sleep apnea, insomnia)	Inattention, hyperactivity, emotional dysregulation	Snoring, restless sleep, daytime fatigue, symptoms improve with sleep correction, abrupt symptom onset
Oppositional defiant disorder	Impulsivity, defiance, difficulty following instructions	Intentional defiance, argumentative behavior, irritability toward authority, behavior mainly situational
Trauma/post-traumatic stress disorder	Inattention, irritability, hypervigilance, sleep problems	History of trauma, intrusive thoughts, avoidance behaviors, exaggerated startle response, emotional numbing