PSEUDO ADHD

Pathologies and conditions mimicking ADHD

By Dr. Claudio Ajmone

"An accurate differential diagnosis allow to discover the real cause and it is a test for the nosography of ADHD"

A - Psychological factors

  1. Adaptation disorder with symptoms of conduct disorder
  2. Ambidextrous children
  3. Bulimia
  4. Child genius
  5. Child vitiated
  6. Child undisciplined
  7. Compulsive obsessive disorder 
  8. Conduct disorder
  9. Depriving institutional care
  10. Disorder of language comprehension
  11. Disrupted and discordant relationships in the families
  12. Depression
  13. Enuresi
  14. Encopresis
  15. Gambling
  16. Generalized Anxiety
  17. Gilles de la Tourette syndrome
  18. Humor disorders
  19. Motivation - Lack of


    20. Learning disability

  20. Executive function - Cognitive measures
  21. Dyscalculia (mathematics)
  22. Motor coordination disorder (DSM-IV), Specific developmental disorder of the motor function (ICD- 10)
  23. Dislexya (reading)
  24. Dysgraphia (writing)
    ..................
  25. Mental retardation (enviromental)
  26. Oppositive-Provocative disorder


    27. Pervasive Developmental Disorders

  27. Childhood autism
  28. Rett Syndrome
  29. Childhood Disintegrative Disorder
  30. Asperger's Syndrome
  31. Pervasive Developmental Disorder Not Otherwise Specified ( including Atypical autism ICD-1O)
  32. Overactive disorder associated with mental retardation and stereotyped movements (ICD-10)

    33. ......................
  33. Post traumatic stress disorder


    34. Psychosis

  34. Dissociative
  35. Bipolar disorder
  36. Personality disorders
  37. Mania
  38. Parents with bipolar disorder
  39. Schizophrenia

    40. ---------------
  40. Maternal Stress during pregnancy
  41. Social phobia
  42. Separation Anxiety
  43. Sexual and physical abuses
  44. Situational problems, environmental, family, school, quality of life
  45. Tics

    46. B - Medical factors

  46. Abscess subclinic post-traumatic
  47. Akathisia
  48. Allergies (15 to 20 percent of the people have some type of allergy, particularly for food)
  49. Anemia
  50. Anesthesia - young children and infants
  51. Basal ganglia - dysregulation in the circuitry
  52. Bronchial asthma
  53. Caudate (functional alterations)
  54. Complement system (blood proteins that play an important role in defending against viral and bacterial infections; i.e. C4B protein)
  55. Carbon Monoxide poisoning
  56. Cardiacs (diseases and disorders)
  57. Celiac disease
  58. Cerebral cysts
  59. Chronic fatigue syndrome
  60. Corpus callosum - macrostructural and microstructural abnormalities
  61. Creatine plus phosphocreatine ( Cr + PCr significantly lower right prefrontal lobe)
  62. Delivery (complications from)
  63. Dermatitis
  64. Elecrtical hypersensitivity
  65. Epilepsy
  66. Fibromyalgia syndrome


    67. Genetic anomalies

  67. 5 HTT variant
  68. 10/3 DAT1 haplotype (spatial inattention)
  69. 16p13.11- excess of chromosome duplications
  70. Aarskog-Scott syndrome
  71. BAIAP2
  72. BDNF variation rs6265
  73. C-1291G - polymorphism (rs1800544) in the promoter region of the (alpha)2A-adrenoceptor gene (ADRA2A)
  74. Congenital or juvenile myotonic dystrophy
  75. Corpus callosum (macrostructural and microstructural abnormalities)
  76. Dopamine beta hydroxylase ( decreased)
  77. Down syndrome
  78. DRD4-7r allele ( additional presence)
  79. Dubowitz syndrome
  80. Fetal alcohol syndrome (FAS)
  81. Hemophilia
  82. hypothalamus-pituitary-adrenal axis ( dysfunctional)
  83. Increased cellular nucleotidase activity
  84. Klinefelter syndrom
  85. Length of the Y chromosome
  86. MAO-B lower
  87. MAO-B variants
  88. Mosaicism for trisomy 17
  89. NRXN1 deletion
  90. PARKIN deletion
  91. Pars triangularis - right smaller length
  92. Phenylketonuria
  93. Prader-Willi syndrome
  94. Rett syndrome
  95. Ring chromosome 8 syndrome
  96. Serotonin 1A receptor C-1019G singlenucleotide polymorphism (HTR1A C-1019G SNP)
  97. Serotonin HRT1B gene 861G allele
  98. Succinyl-CoA: 3-oxoacid CoA-transferase deficiency
  99. TaqI - A polymorphism of ANKK1 (DRD2) gene
  100. Thalamus (Morphological abnormalities)
  101. Temporal information processing impaired
  102. SNAP25 (dysregulation of calcium dynamics)
  103. Val158Met COMT polymorphism
  104. Velocardiofacial syndrome
  105. Ventro-Striatal Reductions
  106. Weinberg syndrome
  107. Wilson disease
  108. X fragile syndrome
    -----------------------
  109. Gray matter - significantly smaller volume
  110. Hearing disorders
  111. Hypertension (prymary)
  112. Hyperthyroidism
  113. Hypothyroidism
  114. Hypoglycemia (Low blood sugar caused by: thyroid, liver, pancreas, adrenal gland, diet)
  115. Hurt and damages to the head
  116. Hypoxia (congenital heart disease, sleep-disordered breathing, asthma, chronic ventilatory impairment, respiratory instability)
  117. Intestinal parasitics ( infestation )
  118. Legg-Calve-Perthes disease
  119. Lesions of the basal forebrain cortical cholinergic system
  120. Lymphocyte muscarinic cholinergic receptor binding (l-MR) lower
  121. Kidney (chronic renal disease)
  122. Korea
  123. Lupus erythematosus (systemic)
  124. Mental retardation (biological and genetic)
  125. Metabolic disorders
  126. Migraine
  127. Obesity
  128. Otitis media
  129. Perinatali (unfavorable factors)
  130. Physiological Vivacity
  131. Platelet monoamine oxidase activity - lower
  132. Porphyria
  133. Post traumatic subclinical access
  134. Premature diabetes
  135. Prenatal (insufficient health and malnutrizione of the mother, drug use)
  136. Putamen ( Structural and functional alterations)
  137. Restless Legs Syndrome
  138. Sensory integration (dysfunction)
  139. Spinal problems
  140. Smith-Magenis Syndrome
  141. Sleep (disturbs of)
  142. Substantia nigra - Structural abnormality of
  143. Toxine exposure


    144. Tumors

  144. Incipient cerebral tumors
  145. Neoplasie of the frontal Lobe
  146. Neuroepiteliale disembrioplastico
  147. Neurofibromatosis type 1 (Von Recklinghausen)
  148. Neurofibromatosis type 2

    149. -----------------

    Vascular cerebral

  149. Lenticulostriate vasculopathy

    150. ----------------
  150. Voluntary or involuntary inhalation of substances


    151. Infections

  151. Adenoids
  152. Candida Albicans
  153. Enterovirus 71
  154. Meningitis
  155. Streptococcus Beta-Emolitico
  156. Tonsillitis
  157. Viral encephalitis

    158. ------------------

    Vison disorders

  158. Accommodative dysfunction
  159. Tracking
  160. Convergence
  161. Visual Acuity - Far
  162. Stereopsis
  163. Visual Acuity - Near
  164. Hyperopia
  165. Color Vision
  166. Visual Motor Integration

    167. ------------------

    C - Psicotropic Substance

  167. Alcohol
  168. Caffeine
  169. Cocaine
  170. D-lysergic acid (LSD)
  171. Eroine
  172. Marijuana
  173. Medicines
  174. Nicotine
  175. Phencyclidine (PCP)

    176. D - Feedeng

    Amino acids (deficit)

  176. Isoleucine
  177. Phenylalanine
  178. Tyrosine
  179. Tryptophan
  180. Histidine

    181. ----------------
  181. Calcium (deficiency of)
  182. Copper (deficiency of)
  183. Food preservative
  184. Food synthetic colouring
  185. Glycyrrhizine - liquorice (high level of)
  186. Iodine (deficiency of)
  187. Ionic Magnesium (low level of Mg(2+))
  188. Iron (deficiency of)
  189. Magnesium (deficiency of)
  190. Malnutrition
  191. Manganese (high level of)
  192. Omega 3 (deficiency of)
  193. Vitamins (excess of)
  194. Vitamin B (deficiency of)
  195. Wrong diet
  196. Zinc (deficiency of)

    197. E - Unfavorable Situations

  197. Chemotherapy for cancer
  198. Hunger
  199. Movement (exercise lack)
  200. New technologies (intensive and/or premature use of the computer, video games, TV)
  201. Physical pain
  202. Wearying


    203. MEDICAMENT

  203. Allergy medication contain anthistamine or stimulants
  204. Antibiotics: frequently cause fatique, same of them have been associated with mental alterations; e.g. cephalosporin
  205. Pitocin (synthetic oxytocin)
  206. Cold medication contain anthistamine or stimulants
  207. Sinus medication contain anthistamine or stimulants
  208. Sleeping medication that can impair alertness and concentration


    209. Antidepressants

  209. Citalopram Hydrobromide
  210. Escitalopram
  211. Fluoxetine
  212. Fluvoxamine
  213. Paroxetine
  214. Sertraline


    215. Antiepileptic medication

  215. Carbamazepine
  216. Phenytoin
  217. Divalproex Sodium
  218. gabapentin


    219. Antipsychotics

  219. Chlorpromazine
  220. Thioridazine
  221. Fluphenazine
  222. Prochlorperazine
  223. Haloperidol
  224. Thiothixene
  225. Olanzapine
  226. Quetiapine
  227. Risperidone


    228. Asthma medication

  228. Antihistaminics
  229. Ephedrine
  230. Pseudoephedrine
  231. Theophylline


    232. Barbiturates

  232. Phenobarbital: 5-ethyl-5-phenyl-1,3-diazinane-2,4,6-trione
  233. Amobarbital: 5-ethyl-5-(3-methylbutyl)-1,3-diazinane-2,4,6-trione
  234. butabarbital: 5-sec-Butyl-5-ethylbarbituric acid
  235. pentobarbital: 5-Ethyl-5-(1-methylbutyl)-2,4,6(1H,3H,5H)-pyrimidinetrione
  236. Secobarbital: 5-(1-methylbutyl)-5-prop-2-enyl-hexahydropyrimidine-2,4,6-trione


    237. Minor tranquilizer, sedatives, sleep medications

  237. Alprazolam
  238. Clonazepam
  239. Chlordiazepoxide
  240. Diazepam
  241. Flurazepam
  242. Lorazepam
  243. Triazolam


    244. Mood stabilizer

  244. Lithium Carbonate
  245. Verapamil


    246. Stimulants, included same used drugs in order to cure the ADHD

  246. Desoxyephedrine
  247. Dextroamphetamine
  248. Methylphenidate
  249. Pemoline


    250. Steroids

  250. Testosterone
  251. Methandrostenolone / methandienone
  252. Nandrolone Decanoate
  253. Nandrolone Phenylpropionate
  254. Boldenone Undecylenate
  255. Stanozolol
  256. Oxymetholone
  257. Oxandrolone
  258. Fluoxymesterone
  259. Trenbolone
  260. Methenolone Enanthate
  261. 4-chlordehydromethyltestosterone
  262. Mesterolone
  263. Mibolerone
  264. Prednisone/steroid hormones: 17-hydroxy-17-(2-hydroxyacetyl)-10,13-dimethyl-7,8,9,10,12,13,14,15,16,17-decahydro-6H- cyclopenta[a]phenanthrene-3,11-dione


    265. Vaccine

  265. With mercury

    266. ---------------------

    F - Pollution

  266. Aluminium (high level of)
  267. Brominated Flame Retardants
  268. Arsenic
  269. Bisphenol
  270. DDT
  271. Fluoride

    272. Organophosphates
  272. Parathion
  273. Melation
  274. Metil parathion
  275. Chlorpyrifos
  276. Diazinon
  277. Dichlorvos
  278. Phosmet
  279. Tetrachlorvinphos
  280. Azinphos metile

    281. -----------------------
  281. Lead (Mild to high levels)
  282. Mercury (high level of)
  283. PCB (Polychlorinated biphenyls)
  284. Phthalates
  285. Polifluoroalkyl
  286. Sniffing materials ( intentionally or unintentionally): such as modeling glue or other house hold products
  287. Trichlorophenol

This is Table 2 of the guidelines developed by the Italian Society of Child and Adolescent Psychiatry (SINPIA) adopted by our National Health Institute (ISS), which lists the differential diagnoses.

Table 2. Differential diagnosis and comorbidity (?)

Psychiatric Disorders

  1. Oppositional-defiant disorder
  2. Conduct Disorder
  3. Mood Disorders
  4. Bipolar Disorder
  5. Anxiety disorders
  6. OCD
  7. Adaptation disorders with symptoms of conduct D.
  8. Gilles de la Tourette syndrome / multiple tics
  9. Personality Disorders
  10. Specific learning disabilities
  11. Mental retardation
  12. Pervasive developmental disorder

    Medical and neurological disorders

  13. Sensory disturbances (deafness, visual defict)
  14. Side effects of medications (antihistamines, beta-agonists, benzodiazepines, phenobarbital)
  15. Epilepsy
  16. Thyroid disease
  17. Abscesses, tumors of the frontal lobe
  18. TBI
  19. Substance Abuse
  20. Lead poisoning

    Developmental Disorders

  21. Physiological Vivacity
  22. Situational problems, environmental, familiars
  23. Inadequate support at school (slight delay, or vice versa, particularly lively intellectual curriculum with "standard")
  24. Altered support environmental, social, family (chaotic environment, divorce, abandonment, abuse)