Is it ADHD? Rule these conditions out first

Is it ADHD? Rule these conditions out first

There are several conditions that can mimic or exacerbate the symptoms of ADHD so it's worth ruling these conditions out before being referred to a paediatrician for an ADHD assessment.

Conditions that can be mistaken for ADHD

There are several conditions that can mimic or make ADHD symptoms worse including epilepsy, anaemia, thyroid conditions, hearing or vision loss.

You really don’t want to be waiting on a two-year waiting list to find out that what you thought was ADHD was actually low iron.

I kid you not.  It happens. 

Inattention, distractability, difficulty in initiating or completing a task, daydreaming, not paying attention.    All sound like hallmarks of Inattentive ADHD right?  Well, don’t jump to seeing a paediatrician just yet.

A test that could have saved a 2-year wait

A local psychiatrist gave me an example of a child she saw who didn’t have ADHD.  What they did have was a thyroid condition that could have been picked up through a simple blood test.

Once that was treated, all the other symptoms and issues disappeared.  A great outcome, eventually.  But that child had waited a loooooong time to get to her. 

What a waste, in something that could have been picked and treated much, much earlier.   

And what a waste of resources for a psychiatrist to be the one to pick that up.  When that happens it delays that child getting the help they need while they wait to get to the top of a very long waitlist.

It also stops children who really need psychiatric help from accessing one of the few child and adolescent psychiatrists we have in WA.

Conditions that can mimic ADHD

Here are a few examples that can mimic or exacerbate the symptoms of ADHD.

Low iron: iron deficiency in kids can look like poor concentration, not staying “on task”, tiredness, behavioural or learning problems.

Thyroid conditions: symptoms can include hyperactivity, anxiety, changes in mood or sleep or trouble concentrating.

Hearing loss: older children are experiencing temporary hearing loss may have a dip in their school grades because they can’t hear the teacher clearly.  They may appear like they are inattentive or daydreaming.  They may not respond when called on.

Vision difficulties: your child may have trouble concentrating, be tired, have headaches and difficulties with their schooling, behaviour and coordination.  

Pre-referral guidelines

Melbourne’s Royal Children’s Hospital publish referral guidelines that require GPs to complete an initial work up prior to referring children for development concerns.

They won’t accept referrals without this information.  

Given the referrals I have been sent, it would probably be a great standard to enforce here too.  Although I’m not aware of it locally, it may exist.  And if it doesn’t then it should.

Too many referrals I see just say “Mum is concerned about ASD/ADHD, please review and provide opinion”.  

The RCH required initial work up includes: 

1. taking a history of the concerns, their onset and family history, 

2. a developmental and neurological examination, 

3. an auditory assessment (especially if there is speech delay) and

4. optometry or opthamology assessment if screening by the Child Health Nurse or GP are abnormal.

You can read the RCH pre-referral guidelines here.

What I suggest

So I suggest to any friends to get some basic tests done through their GP before or as part of their referral to a specialist.

Make sure the child can see, can hear and rule out thyroid conditions or low iron.  

You would be surprised how many have come back to me and said how low their child’s iron was and how once addressed all was OK.  

One poor Mum had worried that her daughter had Dyslexia, but again it turned out to be low iron affecting her ability to concentrate.   Another child started sleeping better once their iron levels improved and was able to concentrate in class.

Your doctor

As always, be guided by your treating doctor as to what is most appropriate for your situation but a basic health check up could answer a few questions and potentially provide a faster solution.  


Melbourne Children’s Hospital.  Pre-referral guidelines.  Accessed 29 July 2023: Primary Care Liaison : Developmental problems (


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