How are ADHD and OCD diagnosed and treated?

How are they diagnosed?

There are some similarities between the diagnostic methods for OCD and ADHD – but because they're different conditions, the signs a clinician checks for aren't the same.

ADHD diagnosis

Diagnosing ADHD can be challenging since there’s no single test to determine if you or your child has it.

But a specialist can make a diagnosis based on a detailed assessment, which may include:

• A physical check-up, including hearing and vision tests, to rule out other issues.
• Talking with you or your child about current symptoms.
• Getting input from people who know you or your child well, like teachers, parents, or partners.

For children, doctors look for at least six signs of inattention or hyperactivity/impulsivity.^[1]

For adults, the cut-off is usually five signs, and they must have been present since childhood. But diagnosing adults can be more complicated, partly because it's not always clear how childhood symptoms show up later in life.

OCD diagnosis

Like ADHD, diagnosing OCD isn’t always straightforward because many of its symptoms overlap with other mental health conditions.

It’s also common for someone with OCD to have other mental health issues, like ADHD, which makes it even harder to diagnose.

A mental health professional will diagnose OCD if:^[2]

• Obsessions or compulsions take more than an hour a day.
• Thoughts feel internal, not caused by outside influences.
• At least one thought or action feels excessive.
• Daily life is disrupted, either at home, at work, or socially.

Differential diagnosis

Differentiating between ADHD and OCD isn’t always easy, but it’s extremely important for choosing the right therapy, because the wrong medication can make things worse.

Example: imagine a child with OCD sitting in class, fixated on a stain on her shoe. Constantly distracted by these obsessive thoughts, she struggles to focus and, as a result, her grades drop.

A teacher might think she’s just not paying attention and suspect ADHD. If she’s misdiagnosed, she could be given a stimulant, which could make her OCD symptoms worse.

There are some things that can help tell ADHD and OCD apart though.

First, impulsive behaviour. People with ADHD often act without thinking or take risks, especially if they have the hyperactive type. In contrast, people with OCD usually avoid risks and prefer sticking to routines or familiar situations.

Second, the way tasks are done. Someone with OCD might follow very specific rules or repeat actions in a certain way. But people with ADHD often find it hard to stick to detailed or structured tasks.

How are they treated?

There are specific and combined options for the treatment for ADHD and OCD.

ADHD treatment

Treatment for ADHD often includes a mix of strategies:

• Therapy: Cognitive Behavioural Therapy (CBT) can help with focus and self-esteem. For children, ADHD parent training teaches parents useful ways to manage behaviour at home.
• Medication: Stimulants are commonly used to improve attention. Non-stimulants may also help with focus and impulsivity.
• Lifestyle support: Exercise, a balanced diet, and better sleep can all support mental health, but they tend to work best alongside therapy or medication.

OCD treatment

Treatments for obsessive compulsive disorder (OCD) include:

• Talking therapy: particularly Exposure and Response Prevention (ERP), which is a form of CBT. This approach helps people with OCD confront their fears and obsessive thoughts without resorting to compulsive behaviours.
• Medicines: usually a type which works by adjusting the balance of chemicals in your brain to help manage symptoms.

Combined treatment for ADHD and OCD

When someone has both ADHD and OCD, they usually need a combined treatment plan. This often includes CBT, particularly with ERP techniques, alongside medications specifically used for OCD and stimulants for ADHD.

References:

1. NHS (2021). Symptoms - Attention Deficit Hyperactivity Disorder (ADHD). NHS.
2. OCD UK (2018). Diagnosing OCD | OCD-UK. OCD UK.