An underactive thyroid or hypothyroidism can cause a child or teen to have the symptoms of ADHD, thus confusing the real diagnosis leading to ADHD misdiagnosis.
In the past three months, we’ve evaluated four children and teens for failure to respond to their ADHD medications, only to discover they all suffered from the same problem; low thyroid hormone levels.
Just like me, you might wonder why we saw so many children and teens who were supposed to be ADHD, but instead were suffering from hypothyroidism in such a short time. After taking a second-look at these cases, I discovered they had several things in common.
In each case, the kids and teens:
- Were inattentive and had a difficult time focusing
- Were making pretty good grades, but teachers and parents thought they were capable of much more
- Were thought to be withdrawn, depressed, or shy
- Had some increased impulsivity-maybe a little more than normal for their age
- Had quit playing a sport or playing with friends because of fatigue or muscle weakness
- Had a poor appetite, but didn’t lose a lot of weight
- Felt cold most of the time
- Slept too much or were sleepy during class or fell asleep during the day when not actively exercising
The symptoms in these kids and teens had worsened over a period of as little as nine months to as long as twenty months. Hypothyroidism rarely develops over-night, because thyroid hormone levels usually drop very slowly as damage to the thyroid gland occurs. As a result, a child might show very few signs or symptoms of thyroid disease for months or even years. That’s exactly what happened in all four of these children with misdiagnosis of ADHD-they had very subtle changes over the course of nine to twenty months.
So what happened to cause these kids and teens to be diagnosed as ADHD and treated with ADHD stimulant drugs when in fact they’ve probably never been ADHD?
Here’s what I think happened…
Both inattentiveness and increased impulsivity are core symptoms of attention deficit hyperactivity disorder or ADHD-ADD and in all four cases, teachers thought the child was ADHD and suggested the initial work-ups.
The fact that these children all had these two core symptoms of ADHD falsely led their teachers and parents to believe they had ADHD.
Once the children’s doctors got information from the parents and teachers, they then assumed the teachers were correct and diagnosed the kids with ADHD-without doing blood tests to rule-out the more than thirty detectable medical conditions that can cause ADHD behavior and misdiagnosis of ADHD.
Then, when their ADHD therapy wasn’t working, the doctors just either increased doses of their ADHD drugs, changed to another drug, or in two cases, added a third and fourth ADHD medication-once again all without doing blood work. (To me that’s sort of like diagnosing a heart attack without doing any tests-almost impossible!)
Making the diagnosis of ADHD is at a minimum, very difficult, as it is first a diagnosis of exclusion-a doctor should exclude the more than 60 things that can look just like ADHD confusing the diagnosis. And… then must make sure the signs and symptoms meet the criteria for inclusion in the American Psychiatric Association DSM-IV guidelines for ADHD.
That’s right; the diagnosis of ADHD is best made by exclusion, then inclusion-not the reverse. Unfortunately, many doctors skip the first requirement in order to satisfy teacher and parent demands for the “quick fix”-pills.
You can protect your child from the misdiagnosis of ADHD and prevent all the bias, discrimination and harassment mislabeled children suffer by:
- Making sure your child’s ADHD doctor knows as much about his or her behavior as possible
- Avoiding biasing the doctor’s opinion by say things like; “His teacher says he is ADHD” or “We’re sure she has ADD-She daydreams all the time.”
- Not putting pressure on your ADHD doctor to skip or rush through the evaluation part and go directly to treatment with ADHD medications
- Asking your ADHD doctor to do all of those blood tests to check for the most common and sometimes uncommon medical conditions that can cause problem behavior or ADHD like behavior
- Realizing that any major change in a child’s life-divorce, death in family-moving to new town-new school-parent losing job-might cause symptoms that look just like ADHD
- Making lifestyle changes (diet, vitamins, essential minerals, exercise) before trying drugs and expensive behavioral therapy
- Being suspicious of changes in his or her behavior, emotions or physical well-being that might indicate the diagnosis is incorrect.
Once appropriately treated, children and teens with symptoms of ADHD who are really suffering from hypothyroidism will usually lose most of their impulsivity, experience improved concentration, make better grades, and will become more social and out-going. And…of course, they also get rid of all of those physical symptoms-fatigue, muscle weakness, sleepiness and appetite changes.
A word of caution: Children, teens and adults can suffer with both ADHD and thyroid disease at the same time! This becomes a much more difficult diagnosis as the hypothyroidism must be treated and controlled before a doctor can adequately assess the possibility of ADHD behavior.
Here are some of our previous articles on hypothyroidism for your review:
Girls misdiagnosed with ADHD often suffer thyroid disorders
ADHD Book-Mistaken for ADHD-ADHD Misdiagnosis
ADHD in Children-Treatment without Drugs