As of 2007, 5.4 million children ages 4 to 17 have been diagnosed with ADHD in the United States. Each year, that number is increasing by 5.5%. Unfortunately, many of the children diagnosed with ADHD might actually not have ADHD but OCD according to a Dec. 28, 2012, United Press International report.
“Obsessive compulsive disorder and attention-deficit hyperactivity disorder may seem similar, but confusing them hurts patient care, Israeli researchers say.”
According to a national survey published by the CDC, “children with ADHD are a rapidly growing group of students within special education programs.”
For many special education teachers, being aware of the possibility that a child might be misdiagnosed with attention-deficit hyperactivity disorder (ADHD) instead of obsessive compulsive disorder (OCD) might make the difference between success and failure in the special education classroom.
One of the most crucial components in distinguishing ADHD from OCD for special education teachers is the awareness of a student’s medication. If a treatment plan for an ADHD student includes Ritalin, “a psychostimulant commonly prescribed to ADHD patients,” and the medication actually worsens the symptoms of an ADHD student, the student might not be suffering from ADHD but from OCD.
Special education teachers are well aware of the classic mental and physical signs and symptoms of ADHD:
- ADHD students have trouble paying close attention to details.
- ADHD students make careless mistakes in schoolwork, work, or other activities due to an uncontrolled mental energy.
- ADHD students have trouble keeping attention on tasks or play activities.
- ADHD students do not appear to be listening when spoken to directly.
- ADHD students have trouble following through on instructions.
- ADHD students have trouble finishing schoolwork, chores, or duties.
- ADHD students have trouble organizing activities.
- ADHD students tend to avoid, dislike, or do not want to do things that require a lot of mental effort for a long period of time (such as schoolwork or homework).
- ADHD students tend to lose things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
- ADHD students are easily distracted.
- ADHD students are often forgetful in daily activities, leave things behind, or do not even remember having been told something.
- ADHD students are physically restless, fidgety, or are unable to remain in a seat for an extended period of time.
- ADHD students display an overwhelming and often uncontrolled energy in running, climbing, or other physical activities.
- ADHD students talk excessively, respond impulsively, and frequently interrupt others.
In contrast to ADHD, however, students with OCD can show different signs and symptoms such as:
- OCD students can have obsessions or compulsions that include repetitive thoughts, impulses, or images.
- OCD students prefer not to deal with certain thoughts, impulses, or images and might ignore a teacher’s instructions (which could be misinterpreted as ADHD)
- OCD students tend to worry excessively about imagined or real-life problems (which can be misdiagnosed as an emotional disability)
- OCD students might repeat certain behaviors like “handwashing, placing things in a specific order, or checking things over and over, (like whether a door is locked) or thoughts (for example, praying, counting, or repeating words silently) over and over again or according to certain rules that must be followed exactly in order to make an obsession go away,” as described by the CDC.
While the difference between an ADHD student and an OCD student appears to be quite evident, all too often students are misdiagnosed with ADHD instead of OCD because of the common symptoms of inattentiveness and restlessness in both ADHD and OCD students.
Any special education teacher unfamiliar with OCD might interpret a student’s constant rearrangement of a pencil or paper as “ADHD fidgeting” instead of the “OCD compulsive behavior” of trying to get an item into the perfect place. A special education teacher might also misinterpret a student’s difficulty to pay attention, memorization, or behavior control as ADHD when in fact a student is preoccupied with an obsessive compulsive behavior and not an attention deficit behavior.
One of the challenges in diagnosing children correctly with ADHD or OCD is the fact that there is no objective diagnostic test for ADHD.
An ADHD diagnosis is based on the subjective observations of parents, teachers, and other caretakers.
The Centers for Disease Control and Prevention (CDC) clearly states on its ADHD webpage that “Deciding if a child has ADHD is a several-step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.”
In its information brochure, the CDC writes that,
“Over the past three decades in the United States, behavioral and learning disorders have emerged as major chronic conditions affecting the development of school-aged children and adolescents. Educators have reported a rise in the number of children with these disorders. Pediatricians have also reported an increased number of children with outpatient visits related to behavioral and emotional disorders. During this period, special education programs have expanded greatly, thereby increasing the number of students receiving services for behavioral and learning disorders. Additionally, a marked increase has also been observed in the number of children with emotional and behavioral disorders who are treated with psychotropic medications. All these trends indicate the need for health surveys to monitor the number and characteristics of children diagnosed with behavioral and learning disorders.”
Being aware that a student that was diagnosed with ADHD might actually be dealing with OCD or ED (emotional disabilities) might make a major difference in a child’s lifetime.
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