When students have difficulties in school, lack of attention is often noticed. We often assume that he/she has ADHD (Attention Deficit/Hyperactivity Disorder). But ADHD is not the only cause of attentional issues. ADHD "imitators" include the following:

• Hearing deficit
• Vision deficit
• Age-appropriate over-activity
• Coordination


• Poor nutrition / malnutrition
• Vitamin deficiency
• Caffeine


• Self-esteem problems
• Speech and receptive language
• Developmental language impairment ~ speech or language delays
• Insufficient sleep (sleep disorder or environmental causes)
• Too much stuff in the bedroom (TV, video games, cell phones, etc.)
• Functional disorders
• Oppositional defiant disorder
• Conduct disorder
• Mood disorder
• Depression
• Dysthymia
• Anxiety disorder
• Realistic fears
• Personality disorder
• Obsessive-compulsive disorder
• PTSD
• Mania or bipolar disorder
• Adjustment disorder with disturbance of behavior
• Situation, environmental, or family problems
• Improper learning environment (unsafe, disruptive)
• Inappropriate school placement (e.g. gifted child, learning disabled, developmentally delayed child in regular classroom)
• Personality conflicts with teachers or peers
• Family psychosocial adversity
• Social disruption (poverty, divorce, moves, deaths, illness in family)
• Unstable / chaotic home setting
• Conflict
• Adult domestic violence
• Abuse, neglect, or both
• Poor parenting (e.g. inappropriate, inconsistent, punitive)
• Level of parental stress
• Parental absence
• Parental psychopatholog
• Fetal alcohol syndrome

• Fragile x syndrome
• Lead blood level
• Thyroid deficienct
• Phenylketonuria


• Petite mal epilepsy
• Seizures
• Sequelae of head trauma
• Thyroid abnormality


• Learning disability
• Mental retardation
• Borderline intellectual functioning


• Frontal lobe abscess
• Neoplasm
• Lead toxicity
• Medication-induced e.g. antihistamines, beta-agonists, Phenobarbital
• Acute or chronic medical illness esp. asthma, allergic rhinitis, eczema, enurisis/encopresis


• Substance abuse (alcohol, OTC medication, illicit substances)


• Pervasive Developmental Disorder (Autism / Asperger's)
• Tourette's syndrome
• Multiple tic disorder