On the last track, we talked about the eight common ADHD symptoms. These
eight symptoms are inattention, impulsivity, difficulty delaying gratification,
emotional overarousal, hyperactivity, noncompliance, social problems,
On this track... we will be discussing five Idiosyncratic, Unique Patterns
of children with ADHD. These patterns may cause the diagnosis to be missed
in a genuine ADHD child. These factors include good social skills, a high
IQ, shyness, no siblings or one-on-one preschool situation with parents,
and ADHD without hyperactivity. In the second part of this track, we will
also talk about the misdiagnosis of ADHD for Learning Disabled.
Five Idiosyncratic, Unique Patterns
Pattern #1 - Good Social Skills
The first pattern causing an ADHD child to be misdiagnosed is good social
skills. ADHD children with good social skills get along well with their
peers. As you are aware, the ADHD symptoms are moderated just enough for
the children to become social assets. For example, a child with ADHD may
be seen as having leadership abilities instead of bossiness tendencies.
Pattern #2 - High IQ
The second pattern that may cause an ADHD child to be misdiagnosed is
a high IQ. For children with ADHD and a high IQ, school is an arena where
they can not only succeed but may actually enjoy life. Because the ADHD
child with a high IQ receives positive reinforcement from his or her
parents and teachers, he or she can often control inappropriate behavior
in the academic environment. However, as you can probably guess, once
the ADHD child with a high IQ gets home from school, he or she often displays
a number of hyperactive symptoms.
Pattern #3 - Shyness
Like the first two patterns of good social skills and a high IQ, the
third pattern of shyness can cause a child with ADHD to be missed. While
most ADHD children seem uncaring about others and socially boorish, the
shy ADHD child will be extremely concerned about others’ opinions.
For this reason, like the ADHD child with a high IQ, the shy ADHD child
will inhibit their hyperactive behavior in public but show the ADHD symptoms
Pattern #4 - No Siblings or One-on-One Preschool Situations
The fourth pattern that causes an ADHD child to be missed is a lack of
siblings or having a one-on-one preschool situation with parents. For
these ADHD children, the symptoms of ADHD do not appear until they begin
school. The lack of ADHD symptoms is often tied to the lack of competition
with siblings. Having reasonably competent and attentive parents can
also produce fairly normal behavior for a while. It is not until these
ADHD children start school and are introduced to competition that they
begin to display ADHD symptoms.
Pattern #5 - ADHD without Hyperactivity
Finally, the fifth pattern that can cause an ADHD child to be missed
is ADHD without hyperactivity. Without hyperactivity, many other symptoms
of ADHD, like emotional overarousal, are moderated better. However, the
child with ADHD but no hyperactivity will still exhibit some symptoms
of ADHD. In these cases, as you know, diagnosis must focus on the existence
of a major concentrational difficulty. As you know, concentrational difficulty
is often displayed through persistent passive noncompliance and disorganization.
Misdiagnosed as Learned Disabled
In addition to the five Idiosyncratic, Unique Patterns that cause ADHD
children to be misdiagnosed, there is also the possibility that the child
with ADHD will be misdiagnosed as Learning Disabled. While ADHD and LD
often overlap, there are children who have one handicap but not the other.
I have found that there are four ways to discriminate ADHD from LD.
4 Ways to Discriminate ADHD from LD
first way to determine if the child has ADHD or LD is to look at his or
her developmental history. By age two or three, most LD-only children
will not show many ADHD symptoms, such as hyperactivity, impulsivity,
or emotional overarousal.
--2. Second, check the child’s IQ. If the
IQ and achievement are compatible and the tests are considered valid,
LD can often be ruled out. For example, If the IQ is below average and
the achievement is below average, the child may simply have LD. However,
if the IQ is above average and the achievement is below average, the
child may be ADHD.
--3. Third, consider past comments by teachers. If during
the early school years the comments were consistently about distractibility
and short attention span, the child is likely ADHD-only.
--4. Fourth, a medication
trial can often eliminate many ADHD symptoms. If the child with ADHD is
medicated and then shows no academic handicaps or underachievement, he
or she is likely ADHD-only.
So if they have no handicaps or underachievement,
the child is only ADHD as opposed to ADHD with LD. Medication cannot remedy
a true learning disability. Do you have any clients who may have been
On this track... we talked about the five Idiosyncratic, Unique Patterns
of good social skills: a high IQ, shyness, no siblings or one-on-one
preschool situation with parents, and ADHD without hyperactivity. We also
discussed the misdiagnosis of ADHD for Learning Disabled.
On the next track, we will talk about how education about
ADHD and counseling for children with ADHD and their parents can work together.
We will talk about three examples of combined education with counseling.
The three examples of combined education with counseling are 1. the "no-fault" notion
about cause, 2. the Symptom Rating Scale, and 3. self-esteem reevaluation.
Peer-Reviewed Journal Article References:
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1), 128–138.
Martel, M. M., Schimmack, U., Nikolas, M., & Nigg, J. T. (2015). Integration of symptom ratings from multiple informants in ADHD diagnosis: A psychometric model with clinical utility. Psychological Assessment, 27(3), 1060–1071.
Sibley, M. H., Pelham, W. E., Jr., Molina, B. S. G., Gnagy, E. M., Waschbusch, D. A., Garefino, A. C., Kuriyan, A. B., Babinski, D. E., & Karch, K. M. (2012). Diagnosing ADHD in adolescence. Journal of Consulting and Clinical Psychology, 80(1), 139–150.
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