Christian Counseling: OCD or ADHD?

In any field of health you have learned professionals who evaluate the same person and end up with different diagnoses. Such is the art of imperfect diagnostic criteria and training and such is the complexity of individuals who present with several similar symptoms and a couple that are different and easily missed because they seem to be minor. It is often these small differences that are ultimately the defining criteria distinguishing one diagnosis from another. Many of these seemingly insignificant symptoms or behaviors or personality traits have yet to be aligned with a specific diagnosis, but a few have.



For example, obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) bear several similarities, such as: impoverished performance of memory, attention, concentration, reaction time, behavioral control and other cognitive tests. A young school age person may appear restless and inattentive in class and be diagnosed with ADHD. However, those symptoms may be the result of intrusive obsessions that disturb attention and increase anxiety, which may be seen as restlessness. In the latter case, the problem is OCD, not ADHD. It gets far more complicated if the person has one disorder and traits of the other disorder or both disorders. 



What helps clinicians arrive at a more uniform diagnosis are the following understandings derived from research:

1. Unlike those with OCD, ADHD troubled persons are impulsive risk-takers who do not often consider consequences. Those with OCD are planners, have great difficulty in decision-making and are overly self-controlled, in my opinion, because of their need to feel secure, which they get in some measure through structure and routine. Hence, they are far less impulsive.

2. Those having ADHD usually improve when given stimulants, such as Ritalin. If the same were dispensed to those with OCD, their symptoms would worsen.



Surprisingly, one simple, but highly important criterion helps distinguish OCD from ADHD--impulsivity, along with the attached thought process of regard for consequences.

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