What could be causing my symptoms of inattention, hyperactivity, and impulsivity, and how can I determine if I have Attention Deficit Hyperactivity Disorder (ADHD) or another condition?

Screening Questions to Differentiate ADHD from Other Conditions

Before assuming you have ADHD, I need to ask you specific questions to determine whether your symptoms represent true ADHD or one of several conditions that mimic it—this distinction is critical because misdiagnosis leads to inappropriate treatment and missed opportunities to address the actual underlying cause. 1, 2

Essential Symptom Timeline Questions

When did your symptoms begin?

• Did you have clear problems with attention, hyperactivity, or impulsivity before age 12? 3
• Can anyone from your childhood (parents, old teachers, childhood friends) confirm you had these difficulties as a child? 3
• Do you have old report cards or school records mentioning attention problems, hyperactivity, or difficulty completing work? 3

Critical pitfall: If symptoms only started in late adolescence or adulthood, this strongly suggests something other than ADHD—such as depression, anxiety, substance use, or emerging trauma-related disorders. 2 True ADHD must have childhood onset, even if it wasn't diagnosed then. 3

Cross-Setting Impairment Questions

Where do your symptoms cause problems?

• Do these difficulties occur in at least two different settings (work AND home, school AND social situations, etc.)? 3
• Are the problems consistent across different environments, or do they only appear in specific situations? 3

Why this matters: ADHD causes pervasive impairment across multiple settings. 3 If problems only occur at work but not at home, or only in social situations but not during structured activities, consider situational stressors, anxiety, or depression instead. 2

Specific Inattention Symptoms

Which of these apply to you?

• Do you frequently fail to give close attention to details or make careless mistakes? 3
• Do you have difficulty sustaining attention during tasks, conversations, or reading? 3
• Do people tell you that you don't seem to listen when spoken to directly? 3
• Do you avoid or intensely dislike tasks requiring sustained mental effort (paperwork, forms, long reports)? 3
• Do you frequently lose necessary items (keys, phone, wallet, paperwork)? 3
• Do you struggle to organize tasks, activities, and manage time effectively? 3

You need at least 5 of these symptoms (6 if under age 17) present for at least 6 months to meet diagnostic criteria. 3

Hyperactivity/Impulsivity Symptoms

Which of these apply to you?

• Do you fidget constantly or feel inner restlessness even when sitting? 3
• Do you have difficulty remaining seated in situations where it's expected? 3
• Do you feel driven by a motor or unable to relax? 3
• Do you interrupt others or blurt out answers before questions are completed? 3
• Do you have difficulty waiting your turn in conversations or situations? 3
• Do you make impulsive decisions without considering consequences? 3

Note: In adults, hyperactivity often manifests as internal restlessness rather than obvious physical activity. 3

Critical Exclusion Questions: Alternative Diagnoses

Trauma and Stress History

Have you experienced:

• Significant trauma, abuse, or neglect (childhood or adult)? 2
• Ongoing toxic stress or adverse life circumstances? 1, 2
• Intrusive memories, nightmares, or flashbacks? 2

Why this matters: Post-traumatic stress disorder and complex trauma produce impulsivity, hyperarousal, and attention difficulties that closely mimic ADHD but require completely different treatment. 2

Mood and Anxiety Disorders

Do you experience:

• Persistent sadness, hopelessness, or loss of interest in activities? 1, 2
• Excessive worry, panic attacks, or overwhelming anxiety? 1, 2
• Did these mood/anxiety symptoms appear before or at the same time as your attention problems? 2

Critical distinction: Depression and anxiety can cause secondary attention problems, but unlike ADHD, they typically emerge later in life rather than being present since childhood. 2 Approximately 10% of adults with recurrent depression/anxiety have underlying ADHD. 3

Substance Use

Current or recent substance use:

• Do you use marijuana, alcohol, stimulants, or other substances regularly? 2
• Did your attention/impulsivity problems worsen after starting substance use? 2
• Are you seeking stimulant medication for performance enhancement rather than genuine symptoms? 1, 2

Critical pitfall: Marijuana and other substances produce effects that mimic ADHD symptoms. 2 Substance use must be ruled out before diagnosing ADHD. 1, 2

Sleep Disorders

Sleep-related questions:

• Do you snore loudly or stop breathing during sleep? 2
• Do you wake feeling unrefreshed despite adequate sleep time? 2
• Has anyone witnessed you stop breathing during sleep? 2

Why this matters: Sleep apnea and other sleep disorders produce daytime hyperactivity, inattention, and impulsive behavior that completely resolves with treatment of the underlying sleep problem. 2

Learning and Developmental Issues

Academic and developmental history:

• Did you have diagnosed learning disabilities as a child? 1, 2
• Do you have language processing difficulties? 1, 2
• Were you ever evaluated for autism spectrum disorder? 1, 2

These conditions commonly present with inattention and behavioral dysregulation that appears impulsive but represents different underlying pathology. 2

Family History

Does anyone in your biological family have:

• Diagnosed ADHD? 3
• Similar attention/hyperactivity problems (even if never formally diagnosed)? 3

ADHD has 70-80% heritability rates, making it one of the most heritable neuropsychiatric conditions. 3 Positive family history significantly increases likelihood of true ADHD. 3

Functional Impairment Assessment

How do your symptoms affect your life?

• Have you lost jobs or been fired due to attention/organizational problems? 3
• Do you struggle to maintain relationships due to impulsivity or inattention? 3
• Have you had academic failures or dropped out of school? 3
• Do you have difficulty managing finances or frequently forget to pay bills? 3

True ADHD causes clear, measurable functional impairment in social, academic, or occupational domains. 3 Symptoms without impairment don't meet diagnostic criteria. 3

Next Steps Based on Your Answers

If you answer YES to:

• Symptoms present before age 12 AND problems in multiple settings AND at least 5-6 symptoms AND no better explanation from trauma/substances/sleep/mood disorders → Formal ADHD evaluation warranted 1, 3

If you answer YES to:

• Recent symptom onset (after age 12) OR symptoms only in one setting OR significant trauma history OR active substance use OR untreated sleep/mood disorder → These conditions must be evaluated and treated first before considering ADHD 2

Common diagnostic error to avoid: The majority of individuals presenting with ADHD-like symptoms actually meet criteria for another mental disorder. 1, 2 Systematic evaluation for alternative and coexisting conditions is mandatory, not optional. 2