Why the question matters
The DSM-5-TR criteria for ADHD include that the symptoms are not better explained by another condition, so adult assessments spend real time on other causes. The CDC notes that a medical and psychological exam may be needed to rule out other health problems that can cause symptoms like ADHD, or that often occur with it, such as anxiety, depression, sleep problems, alcohol or substance misuse, or learning disabilities.
It is not always one or the other. NIMH notes that ADHD often co-occurs with other mental disorders and can make them harder to treat. This is also why the ADHD check gives indicators rather than a diagnosis.
Anxiety
Generalized anxiety disorder can bring restlessness, trouble relaxing, a hard time concentrating and poor sleep, according to NIMH, and people with it may feel irritable, on edge or tired. From the inside, a mind busy with worry can feel very like a mind that will not stay on task.
One difference clinicians explore is timing. Distraction driven by anxiety tends to follow worries and stressful periods. ADHD symptoms are expected to have been present since childhood and across settings, including calm times.
Depression
NIMH lists difficulty concentrating, remembering or making decisions among the common symptoms of depression, along with fatigue, feeling slowed down, and irritability or restlessness. Low mood can make every task feel heavy and easy to put off.
Again, the history matters: whether the concentration problems arrived with the low mood or were there long before it. Both can be present at once, and a clinician can help untangle them.
Sleep loss
The National Heart, Lung, and Blood Institute explains that sleep deficiency can interfere with work, school, driving and social functioning, and can make it harder to learn, focus and react. It can also leave you feeling frustrated, cranky or worried. A run of short nights can noticeably change how you do on attention tasks.
Sleep and ADHD are tangled together: NIMH notes that sleep problems affect up to 70% of adults with ADHD. That is why clinicians ask about sleep, and why it is worth doing any attention task when you are reasonably rested.
Burnout and chronic stress
The World Health Organization describes burnout as an occupational phenomenon, not a medical condition, resulting from chronic workplace stress that has not been successfully managed. Its three dimensions are exhaustion, mental distance or cynicism about one’s job, and reduced professional efficacy. Exhaustion and disengagement can easily look like poor focus. The WHO is explicit that the term refers to work and should not be used for experiences in other areas of life.
Burnout is tied to work and to a period of time. Difficulties that go back to childhood and appear in every part of life point in a different direction, and the two can exist together.
Thyroid and other physical causes
Thyroid problems can affect concentration and energy. The NHS lists nervousness, anxiety, hyperactivity and difficulty sleeping among the symptoms of an overactive thyroid, and difficulty concentrating or thinking clearly, tiredness and low mood among the symptoms of an underactive thyroid. Blood tests can check thyroid function, which is one reason a doctor may suggest a physical check-up.
The CDC’s list of things to consider also includes alcohol or substance misuse and learning disabilities. Medicines can matter too, so mention anything you take.
Other neurodevelopmental differences
When an adult raises attention problems, the NHS says a GP may also consider conditions such as autism, Tourette’s or anxiety. A learning difficulty such as dyslexia can also make reading-heavy work slow and tiring, and the NHS notes that people with ADHD may also have one. These are not alternatives to rule out so much as possibilities to understand, because more than one can be present.
Questions that help tell them apart
You cannot sort this out on your own, but these questions make a first conversation with a doctor more useful:
- When did it start? Since childhood, or since a particular job, loss, illness or change in sleep?
- Where does it happen? In every part of life, or mainly in one setting?
- Does it come and go? Does it ease on holiday, after good sleep or when stress drops?
- What else comes with it? Low mood, constant worry, trouble sleeping, weight change, or feeling cold or hot all the time?
- What are you taking? Medicines, alcohol, caffeine and other substances.
Why a task profile is an indicator
An attention task records how you responded on one occasion. It cannot see why. A slow, uneven run on the go/no-go or flanker task could reflect a long-standing attention difficulty, a bad night, a worry you could not put down, a medicine or a phone notification. The Neuropsych attention profile shows your answers and task results side by side, as indicators to discuss, not as a diagnosis.
If you do the check, pick a time of day that is normal for you, after a reasonable night’s sleep, somewhere quiet and on a device you know. If you repeat it on another day and the results change a lot, that is useful information too.
If the difficulties are recent, began with a particular stress or come with physical symptoms, start with a general doctor. If they have been with you since childhood across many areas of life, our guide to what happens after an online ADHD test explains the assessment route, and signs of ADHD in adults describes the adult criteria.
General information, not a diagnosis
This guide explains how ADHD is described and assessed. It does not replace an assessment by a qualified clinician, and the sources it cites do not endorse Neuropsych.
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022. https://www.psychiatry.org/psychiatrists/practice/dsm
- Centers for Disease Control and Prevention. ADHD in Adults. https://www.cdc.gov/adhd/about/adhd-in-adults.html
- National Institute of Mental Health. ADHD in Adults: 4 Things to Know. https://www.nimh.nih.gov/health/publications/adhd-what-you-need-to-know
- National Institute of Mental Health. Generalized Anxiety Disorder: What You Need to Know. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad
- National Institute of Mental Health. Depression. https://www.nimh.nih.gov/health/publications/depression
- National Heart, Lung, and Blood Institute. Sleep Deprivation and Deficiency. https://www.nhlbi.nih.gov/health/sleep-deprivation
- World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases. 28 May 2019. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases
- NHS. Overactive thyroid (hyperthyroidism): symptoms. https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/symptoms/
- NHS. Underactive thyroid (hypothyroidism). https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/