Distinguishing between Anxiety, ADHD, and Learning Disorders

Which is it and how can I figure it out?

Dear SMA Community,

As a pediatrician, several times a week, I see a patient in the office that has been flagged by their school as having some “concerns,” but with no clear direction in what to do next. Parents often feel confused about what is wrong with their child and don’t know how to go about getting the right support. They ask questions like, “Is my child withdrawn because of anxiety or is it something else?” and “Is my child having difficulty focusing because of ADHD or is trouble understanding the school work?”

Many conditions in pediatrics such as anxiety, ADHD, and learning disorders can manifest with very similar symptoms. Determining what is going on can be even more complicated for kids who also have Selective Mutism, whose symptoms can look different depending on the setting or the people who are around and who may struggle to answer questions about their emotions and experiences. It is also common for some of these conditions to overlap and present together as a comorbidity. Therefore, behaviors alone like difficulty completing a class assignment, can be non-specific and cannot always delineate amongst anxiety, ADHD, or learning disorders.

A first step is to discuss your concerns with your pediatrician. As pediatricians, we recognize that we are the medical home for our patients. We can start by gathering more clinical information and helping guide the family to the correct resources in getting a diagnosis and treatment plan. When talking with your pediatrician about your concerns, it can be helpful to share the following information:

· What your concerns are, with two or three succinct examples
· Where the behaviors are present
· When the behaviors began and how often they happen
· How the behaviors are impacting your child’s life

Although further evaluation is often warranted, there are some standard questionnaires that can be completed with a primary care doctor to determine if a child has anxiety or ADHD. These questionnaires can be helpful in systematically assessing symptoms and determining whether a child’s behaviors are typical or atypical when compared to same aged peers. When symptoms differ significantly from expectations or if your child is highly distressed your pediatrician may recommend further consultation/evaluation with a mental health professional (e.g., psychologist, social worker, licensed mental health counselor, psychiatrist). Your pediatrician will likely have a referral list of qualified providers in your local area. If selective mutism/anxiety is a presenting concern, you also may wish to consult SMA’s directory of treating professionals.

If a child is also having academic difficulties at school and has not shown improvements through RtI (Response to Intervention) services, it may be important to evaluate for a learning disorder. Upon parental request, public schools generally offer psychoeducational testing specific to the identified areas of concern, which can be helpful to determine a student’s strengths and weaknesses, whether or not a child meets criteria for a learning (or other) disorder as set forth by the federal Individuals with Disabilities Education Act (IDEA), and what special education services a child may be eligible for and benefit from, if a school-based team determines criteria have been met. This type of evaluation is provided at no cost. More information on this special education process can be found here. However, the role of this evaluation is to determine if a child meets criteria within select disability categories, determine if the areas of concern are having a significant functional impact in the school setting, and develop a school plan that will help the child continue to make academic progress through additional special education support and classroom accommodations. Schools typically cannot provide a definitive diagnosis for any disorder. For families who want more information about their child’s overall functioning, an alternative option could be to pursue a comprehensive assessment with a neuropsychiatrist, neuropsychologist or clinical psychologist who can evaluate for mental health disorders, learning disorders, and other behavioral or developmental disorders. It is important to note that diagnoses provided through these kinds of evaluations and recommendations identified in the evaluation do not guarantee the child will receive further support or services in the school setting. Decisions about school programming will be made in collaboration with the child’s school-based team.

Pediatricians are well aware of the limited mental health resources available for children and are doing more and more to arm themselves with the knowledge and understanding of starting the evaluation and treatment process for patients so that they are not waiting for an unreasonable amount of time to be seen. Ultimately, parents should feel comfortable in discussing these issues with their child’s pediatrician as a first step in the evaluation process.

Sincerely,
Rupal Upadhyay, MD
SMA Board of Directors