While this can help them with things like working, doing homework, or interacting with other people, the compensatory behaviors can be exhausting and are often not healthy long-term. When someone masks their ADHD symptoms, they might present with other symptoms, and they might have more than one diagnosis. According to the Centers for Disease Control, six out of ten children with ADHD have at least one additional diagnosis, and the National Institute of Health estimates that eight out of 10 adults with ADHD have at least one comorbidity. ADHD can present differently depending on what other diagnoses the person might have. If you have concerns about a diagnosis you have been given, talk to your provider. They can answer your questions about your diagnosis, and they can give referral information for a second opinion if you need one. This article is not intended to diagnose or treat any condition.
Depressive Disorders
People with ADHD often have difficulty with memory, task initiation, and sustained focus. These executive functions can also be symptoms of depression. Additionally, people with ADHD often experience low self-esteem due to frustration and misunderstanding of their difficulties, as well as external messages that they are “lazy” or “just not trying hard enough.” If someone has issues focusing due to depression, often their focus will improve while they are not in a depressive episode. Medication for depression might also alleviate symptoms if they are related to a depressive disorder. The organization To Write Love on Her Arms states, “The first lie depression told me was that I did not have depression.” Because of this, it can be surprising to learn that the moods and functional issues you are experiencing could be related to depression. However, if treatment for your depression does not lead to improved focus and executive functioning, you might consider asking your treatment team about assessing for additional diagnoses, including ADHD.
Anxiety
Fidgeting, difficulty staying still, getting overwhelmed, and losing focus can all occur due to anxiety as well as ADHD. Many people with ADHD can develop anxiety as a method to compensate for their ADHD symptoms. The cortisol and adrenaline that anxiety can trigger can allow people with ADHD to focus, but in the long-term, this is not healthy. If you experience focus issues due to anxiety, you will likely experience improved focus as your anxiety gets better. However, if your focus issues seem to get worse as your anxiety improves (or if your anxiety symptoms seem unresponsive to treatment), it could be because the anxiety is compensating for ADHD. Additionally, if anxiety is the cause of attention problems, your anxiety will increase before you start to struggle with focus. If you notice that the anxiety seems to increase in response to difficulty focusing, this might mean that the focus issue is triggering the anxiety rather than the other way around.
Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is an impulse control disorder that manifests behaviorally. Those with ODD might struggle with dishonesty, task refusal, irritability, and frequent conflicts with peers and authority figures. Typically, ODD manifests in early childhood but can develop in adolescence. Although ADHD symptoms are treatable and manageable, someone with managed ADHD symptoms still has ADHD.
Bipolar Disorder
Although ADHD is something people are born with, symptoms do not always manifest in early childhood. For many, the structure provided by the school system as well as supervision by parents or guardians allowed them to thrive through high school, and they first notice that they are struggling when they enter college. The scheduling flexibility and decreased oversight allow attention issues and impulsive behaviors to manifest. Sometimes, this can make it seem like the symptoms are due to a new mental health issue rather than a preexisting neurodivergence that was not previously causing behaviors or functional issues. These symptoms can be confused with manic or hypomanic symptoms of bipolar disorder. People with ADHD often experience “racing thoughts,” feeling like their mind is going fast and jumping between topics quickly. They might also struggle to fall asleep or stay asleep because their thoughts keep going after they lie down. Furthermore, although ADHD is characterized by attention “deficits,” people with ADHD can often hyper-focus on topics of interest. Sometimes, these thought patterns and behaviors are misdiagnosed as manic or hypomanic episodes. If your hyperactive symptoms are ongoing or chronic, they could be due to ADHD. Manic and hypomanic symptoms tend to last a couple of weeks or months before subsiding. Providers must determine whether symptoms are chronic or episodic as well as the onset of symptoms when differentiating ADHD and bipolar disorder.
A Word From Verywell
ADHD is sometimes misunderstood, even by providers. If you feel that your symptoms do not match your diagnosis or diagnoses, you can explore this. It is OK to question a diagnosis, and the person who diagnosed you should be able to answer your questions or provide you with resources to get these answers. Your treatment team can provide referral information for testing or a second opinion if needed.
