By James H. Legge III, Certified Nurse Practitioner, Psychiatric Center of Northwest Ohio

Over the past 15 years, there has been a significant focus on the integration of digital technology, along with an oversupply of information. What was once confined to computer screens is now readily accessible at our fingertips through smartphones. Information flows faster and across a broader spectrum than ever before in history. Examining generations by birth years, Millennials were introduced to technology and became fairly tech-savvy by the early 2000s. They were followed by Generation Z and now Generation Alpha, both of whom have been immersed in an overwhelming abundance of technology.

With the rapid growth and accessibility of information, more so with self-diagnosis practices, we are noticing trends not only in psychiatry but also in psychology, particularly concerning attention-deficit/hyperactivity disorder (ADHD). However, there is a risk of misdiagnosing ADHD when the true underlying condition could be obsessive-compulsive disorder (OCD) or more related to a neurodevelopmental disorder such as Autism. While ADHD and OCD have distinct core differences, their overlapping symptoms can blur diagnostic lines, leading to ineffective treatment or even worsening symptoms.

Many clinicians are encountering an overwhelming number of ADHD evaluation requests. However, it is crucial for clinicians, educators and parents to recognize the key distinctions between ADHD and OCD to ensure accurate diagnosis and appropriate intervention.

Overlapping symptoms and the risk of misdiagnosis
ADHD is generally characterized by impulsivity, hyperactivity and inattention. It can present as a combined type or as a singular subset. In contrast, OCD is marked by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing stress. Despite these fundamental differences, OCD can also manifest as distractibility and difficulty with tasks, and can alter executive function.

Due to this symptom overlap, individuals with OCD are sometimes mistakenly diagnosed with an attention-deficit disorder, particularly children who struggle to articulate their experiences with intrusive thoughts and repetitive behaviors. A common misinterpretation arises when assessing task completion. People with OCD often report that they have a difficult time finishing tasks, but a more thorough clinical interview often reveals that they struggle to even start tasks due to a fear of not achieving perfection.

Repetitive checking, for instance, is sometimes mistaken for the absentmindedness and forgetfulness associated with ADHD. However, in OCD such behaviors stem from a need for perfection rather than simple inattentiveness.

A hallmark feature of OCD is that compulsions drive anxiety, whereas individuals with ADHD generally do not experience the same level of distress over making mistakes. 

Consequences of misdiagnosis
Misdiagnosing ADHD in place of OCD is particularly concerning and can carry serious consequences. Studies have shown that some individuals with OCD seek out amphetamine-based medications used to treat ADHD because these drugs may allow compulsions to flow more easily—though they typically exacerbate anxiety.

From a clinical standpoint, the treatment approaches for ADHD and OCD are vastly different. ADHD is typically managed with stimulant or non-stimulant medications designed to reduce impulsivity and improve attention, sometimes even helping to decrease certain behaviors in children. However, using these medications to treat anxiety or OCD can worsen compulsions, creating a distressing cycle that may make the condition even harder to distinguish—even for skilled professionals.

In contrast, the standard treatment for OCD primarily involves selective serotonin reuptake inhibitors (SSRIs) along with behavioral interventions such as psychotherapy. OCD treatment focuses on helping individuals manage intrusive thoughts and gain control over compulsions by regulating the emotions associated with discomfort.

A key red flag from a clinical treatment standpoint is when ADHD medications fail to work as expected. If a patient is prescribed norepinephrine- or dopamine-targeting drugs and experiences heightened anxiety, it may perpetuate executive dysfunction. This can sometimes lead to increased doses of stimulant or non-stimulant medications, further worsening symptoms. As a result, individuals may experience frustration, self-doubt, and a decline in overall mental health.

A clear diagnosis, supported by structured interviews and, when necessary, neuropsychological testing, is crucial in distinguishing between ADHD and OCD and ensuring appropriate treatment. Additionally, obtaining collateral information from parents, teachers, and other caregivers can provide invaluable insight into a child’s behavior across different environments.

Conclusion
Ensuring accurate diagnosis of OCD and ADHD is paramount in providing individuals with the proper care they need. By distinguishing between these conditions, we can pave the way for more effective interventions and better long-term outcomes for those affected.