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Is It ADHD, OCD, or Both?

A child is easily distracted and has a hard time finishing tasks. Is it attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD)? The truth is, it could be either.

“It’s not easy to distinguish between the two,” says Carla Allan, PhD, co-director of the ADHD Specialty Clinic at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. “For kids who aren’t functioning well in their ability to go to school, [the disorders] can look the same.”

To make things even more confusing, up to half of all kids with ADHD have another condition, which could be OCD. So if it’s not one or the other, it could be both.

Although both disorders seem to cause the same negative outcome for children, such as poor grades in school, ADHD symptoms and OCD symptoms themselves are quite different. Doctors look for specific signs of each when they’re making a diagnosis.

ADHD and OCD: Underfocused vs. Overfocused

In Allan’s clinic, it’s standard for every child who walks through the door to be evaluated for OCD symptoms. One of the things that doctors look at is a child’s ability to focus.

Kids who have OCD tend to be hyperfocused, she says. They can’t get a task done because they’re focused on one small aspect of it that distracts them from the big picture. Kids with ADHD, however, tend to be underfocused. They move from one part of a task to the next quickly and they’re not organized, she explains.

Both groups of kids will have a hard time finishing their tasks, but for a different set of reasons.

Classic Signs of ADHD and OCD

Some parents tell Allan that their child does things that don’t necessarily fall under ADHD symptoms, but they don’t know what to call the behavior. It could be OCD if the behaviors include:

  • Obsessively checking on things, such as making sure the stove is turned off or the front door is locked, to the point that it’s difficult to go to sleep at night
  • A preference for symmetry and order
  • Persistent washing, such as washing hands for two hours or more a day, or other rituals
  • Hoarding or collecting items like magazines

Keep in mind that some of these behaviors are part of normal development. It’s not OCD unless the child is doing the behaviors for more than an hour every day and the behaviors create an impairment for the child, Allan says.

ADHD symptoms, on the other hand, include:

  • Being distracted
  • Having trouble concentrating on things like homework
  • Restlessness
  • Daydreaming
  • Being impulsive
  • Completing tasks slowly

Is It Both ADHD and OCD?

The degree to which your child’s ADHD medication is working could be a red flag about possible OCD. If you notice that there’s some improvement but your child is still having problems, it could mean that the medication is working for ADHD symptoms, but not those associated with OCD. Each disorder responds to different medications, Allan says.

If you suspect your child is experiencing something more than ADHD, it’s important to have him checked for an additional condition. Research has shown that anywhere from 6 percent to 33 percent of kids with OCD have ADHD, and kids who have both tend to have poorer outcomes, Allan says.

Once you know for certain that your child has both disorders, both can be treated with the appropriate medications and behavioral therapies — and that can lead to big improvements for your child.


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