ADHD and related conditions in children

When a child is assessed for ADHD, the question is not only "does my child have ADHD?" It is also "is anything else going on?" ADHD and related conditions often come together: many children with ADHD have at least one other condition, and some conditions can look very like ADHD from the outside. NICE guidance asks that every ADHD assessment includes a look at coexisting conditions and the child's physical health, and for good reason.

This guide explains the conditions a paediatrician keeps in mind alongside ADHD, why each matters, and where families can go for help.

Why a paediatrician looks beyond ADHD

Difficulties with attention and behaviour can have more than one cause. A child who cannot concentrate may have ADHD. They may also be anxious, short of sleep, struggling to read, or unable to hear the teacher clearly. Often it is a combination.

Getting the whole picture matters for two reasons. First, it makes the diagnosis more accurate. Second, it means support can be aimed at everything your child finds hard, not just one part of it. NICE notes that other conditions are distinct from ADHD and may need different adjustments at school.

Both of our doctors are consultant paediatricians, not psychiatrists. That means they look at your child's general health and development as well as their attention and behaviour.

Anxiety and low mood

Anxiety is common in children with ADHD, and NICE lists mood disorders such as anxiety and depression among the groups in which ADHD is seen more often. The two can also be confused. The NHS lists poor concentration, poor sleep, irritability, outbursts and feeling tense and fidgety among the signs of anxiety in children, all of which can look like ADHD.

Low mood can creep in when a child has spent years being told off, falling behind or feeling different. The NHS notes that people with ADHD may be more likely to have anxiety or depression. Spotting this early, and helping your child understand that their difficulties have a reason, can make a real difference to their self-esteem.

Your GP is the usual first step for anxiety or low mood, and can refer to local children and young people's mental health services if needed. If you are ever worried that your child may harm themselves, contact your GP urgently or call NHS 111, or 999 in an emergency.

Sleep problems

Many children with ADHD find it hard to settle at night, and sleep problems are common alongside ADHD. Poor sleep makes concentration, mood and behaviour harder for any child, so it can make ADHD look worse, or look like ADHD when the main problem is sleep. NICE asks doctors to consider sleep when planning treatment.

A calm, regular bedtime routine, a dark and quiet bedroom, and screens off well before bed are good places to start. Our guide to parenting a child with ADHD has more practical ideas.

Tics and Tourette's syndrome

Tics are sudden, repeated movements or sounds a child does not choose to make, such as blinking, shrugging, sniffing or throat clearing. Lots of children have tics at some point, and this does not always mean Tourette's syndrome. The NHS notes that Tourette's often occurs alongside ADHD or OCD (obsessive compulsive disorder), and that symptoms usually start around the age of 6.

Tics can be worse with stress, excitement or tiredness. If tics are causing your child problems, your GP can refer to a specialist. Knowing about tics also matters for ADHD treatment planning, so tell the doctor if your child has them.

Dyslexia and other learning difficulties

Dyslexia mainly affects reading, writing and spelling. It can also affect memory, organisation and working with numbers. It does not affect intelligence. Children with dyslexia can become frustrated, which may lead to disruptive behaviour or withdrawal, and that can look like ADHD.

NICE's clinical summaries note that dyslexia and dyscalculia (difficulty with numbers) are more common in children with ADHD. The NHS advises that a good first step is to talk to the school's SENCO. A dyslexia assessment is usually done by an educational psychologist or specialist teacher, not a doctor.

Dyspraxia (developmental co-ordination disorder)

Developmental co-ordination disorder (DCD), often called dyspraxia, affects physical co-ordination. A child may seem clumsy, find handwriting, dressing or using cutlery hard, and struggle with sport. Being born early and a family history are risk factors for DCD as well as for ADHD, and the two are often seen together.

DCD does not affect intelligence, but it can make schoolwork, especially writing, much harder. Your GP, health visitor or the school's SENCO can refer to an occupational therapist or paediatrician for assessment.

Speech and language difficulties

Some children with ADHD also have difficulties understanding language or expressing themselves. A child who does not fully understand a spoken instruction may look as if they are not listening, or may give up and become frustrated. Language and communication difficulties are among the conditions often seen alongside ADHD.

Your GP or your child's school can advise on how to reach local speech and language therapy services.

Oppositional behaviour

Some children with ADHD also show a persistent pattern of angry, defiant or argumentative behaviour, especially towards adults in authority. When this is marked, it may be described as oppositional defiant disorder (ODD). NICE lists ODD and conduct disorder among the conditions in which ADHD is seen more often.

This is not a sign of bad parenting. For children with ADHD and oppositional behaviour, NICE recommends offering parents a parent-training programme, and is clear that this does not imply bad parenting. Its aim is to help parents meet a child's above-average needs. Dr Zoric has written about how mothers of these children can be wrongly blamed: see when parents feel blamed in ADHD pathways.

Hearing and vision

A child who cannot hear the teacher properly, or cannot see the board, can easily look distracted or uninterested. It is worth ruling these out, especially if there is any doubt.

• Your GP can refer your child to an audiologist for a free NHS hearing test.
• NHS sight tests at an optician are free for children under 16, and for young people under 19 in full-time education.

Why general health matters

Physical health can affect attention, energy and mood. NICE asks that an ADHD assessment includes the child's physical health, and certain conditions, such as epilepsy, are linked to a higher chance of ADHD. A paediatrician will ask about your child's birth, development, medical history and family history, because each of these can shed light on what is going on.

General health also matters for treatment. If medication is ever considered for ADHD, NICE asks for a baseline health assessment first.

Autism

Autism and ADHD often occur together, and some of their signs overlap. Our guide ADHD or autism explains the differences and what happens if autism is suspected.

What BZ Clinic does if it finds something else

BZ Clinic assesses ADHD only. During the assessment, the doctor screens for other conditions, including autism, Tourette's syndrome, dyspraxia, dyslexia and other learning difficulties. If something else seems likely, the doctor will explain this and signpost you to the right service. The doctor can usually give you a clear answer on the day, with recommendations for home and school, and your GP is sent the letter after the assessment.

Questions parents ask