Question:

I have a 6 yr old child who at the age of 3 yrs was diagnosed with ADHD and has been on 5 different medications (now on concirta 36mg) and is still bouncing of the walls both in school and at home...It has been bought to my attention that my son may be suffering from anxiety more than ADHD...I have tried to research every thing I can on the subject but still can't come to any conclusion on the issue...I should tell you that my husband and I suffer from mental health issues...also I had a very hard time caring my son for the nine months of pregnancy...He was born at over 10lbs and he had to be put on a respirator at birth...(I have type 1 diabetes)I guess what I'm asking is how do I tell if this is ADHD or anxiety?

Thank You, Robin

Answer:

This is a good question. Often neither treating physicians or parents question the role that anxiety might be playing in their child's inattentive "symptoms". A doctor, when making a diagnosis of ADHD or anxiety has to rely on a checklist of symptoms that make up the disorder. Unlike many other medical diagnoses, there is no way to "prove" that a child has either of these disorders by blood tests or a physical examination. A child may have both anxiety and Attention Deficit Disorder. When you look at the following lists of criterion (attached) for these two diagnoses, you might quickly see that there is a lot of overlap in those symptoms which might interfere with a child's behavior in a classroom setting.

One of the biggest differences is a child "worrying" and expressing concerns about themselves and their performance. Children with ADHD are less likely to spend excessive time "worrying", although they can frequently be upset about their difficulties concentrating and their bad behavior.

It is also important for you to know that many of the medications for Attention Deficit Hyperactivity Disorder, mainly the stimulants, also have side effects of increasing or producing feelings that are similar to worrying or anxiety. Some children will pick at or bite their skin or start speaking more rapidly.

A family history of mental health difficulties could be related to ADHD as well as anxiety. A history of a difficult pregnancy and early newborn period could make a child more prone to Attention Deficit Disorders as well as general "neurological irritability", making his responses to situations in the environment more than that of other children.

I would suggest that you attempt to find a physician who will talk with your son, preferably when off stimulants, and see what he has to say about his behavior and feelings. There are also a variety of behavioral checklists that could be helpful in differentiating anxiety from pure ADHD.

The good news about all of this discussion is that there are medications that target both anxiety and Attention Deficit Disorder. An older one that is still around is Imipramine (Tofranil). There are also some of the newer antidepressants that also target both symptoms. You should ask your son's doctor about these. It is better and response is more clear if the current medication is discontinued and the symptoms evaluated prior to introducing a new medication.

DSM IV:

http://www.behavenet.com/capsules/disorders/gad.htm

http://www.behavenet.com/capsules/disorders/adhd.htm