64 Neurodevelopmental Disorders
frequent multiple tics can be mistaken for the generalized fidgetiness of ADHD. Prolonged
observation may be needed to differentiate fidgetiness from bouts of multiple tics.
Specific learning disorder. Children with specific learning disorder may appear inat-
tentive because of frustration, lack of interest, or limited ab ility. However, inattention in
individuals with a specific learning disorder  who do not have ADHD is not impairing out-
side of academic work.
Intellectual disability (intell ectual developmental disorder). Symptoms of ADHD are
common among children placed in academic sett ings that are inappropriate to their intel-
lectual ability. In such cases, the symptoms are not evident during non-academic tasks. A
diagnosis of ADHD in intellectual disability requires that inattention or hyperactivity be
excessive for mental age.
Autism spectrum disorder. Individuals with ADHD and those with autism spectrum
disorder exhibit inattention, social dysfunction, and difficult-to-manage behavior. The so-
cial dysfunction and peer rejection seen in individuals with ADHD must be distinguished
from the social disengagement, isolation, an d indifference to facial and tonal communica-
tion cues seen in individuals with autism sp ectrum disorder. Childr en with autism spec-
trum disorder may display tantru ms because of an inability to tolerate a change from their
expected course of events. In contrast, child ren with ADHD may misbehave or have a tan-
trum during a major transition because of impulsivity or poor self-control.
Reactive attachment disorder. Children with reactive attachment disorder may show
social disinhibition, but not the full ADHD symptom cluster, and display other features
such as a lack of enduring relationship s that are not characteristic of ADHD.
Anxiety disorders. ADHD shares symptoms of inattent ion with anxiety disorders. Indi-