View Full Version : Psychiatrist is contradicting what I've researched about ADD, and now I'm confused


Brooks1138
03-19-17, 03:22 PM
Hey everyone! So today I had a meeting with an ADD/ADHD specialist; I've suspected for years that I have ADD, I've done a tonne of research into it and so many of the symptoms ring true. My incessant procrastination and lack of focus is making my university work near-impossible to finish, so if I want to get help for it as soon as I can.

Thing is, the psychiatrist I met with said something kinda strange - apparently she's hesitant to diagnose me with ADHD-Inattentive-type (despite me displaying many of the symptoms) because 1) I've never been hyperactive, and 2) I can usually focus on things I enjoy or have an interest in.

Does that sound right to you guys? I thought it was totally normal for ADD adults to have never shown signs of hyperactivity, but she told me people generally start off hyperactive and inattentive then just lose the hyperactivity as they get older... obviously that may be the case for many people, but is that really what generally happens to most people? I guess I was always too busy daydreaming to find the time to be hyperactive.

And as for the focus thing, again isn't it normal for people with ADD to find that their symptoms aren't so bad if they're doing something they enjoy? Again, she implied this isn't the case.

I'd really appreciate some help clearing this up, so what do you guys think? Is my psychiatrist right or are you as dubious as I am?

Postulate
03-19-17, 04:07 PM
Hey everyone! So today I had a meeting with an ADD/ADHD specialist; I've suspected for years that I have ADD, I've done a tonne of research into it and so many of the symptoms ring true. My incessant procrastination and lack of focus is making my university work near-impossible to finish, so if I want to get help for it as soon as I can.

Thing is, the psychiatrist I met with said something kinda strange - apparently she's hesitant to diagnose me with ADHD-Inattentive-type (despite me displaying many of the symptoms) because 1) I've never been hyperactive, and 2) I can usually focus on things I enjoy or have an interest in.

Does that sound right to you guys? I thought it was totally normal for ADD adults to have never shown signs of hyperactivity, but she told me people generally start off hyperactive and inattentive then just lose the hyperactivity as they get older... obviously that may be the case for many people, but is that really what generally happens to most people? I guess I was always too busy daydreaming to find the time to be hyperactive.

And as for the focus thing, again isn't it normal for people with ADD to find that their symptoms aren't so bad if they're doing something they enjoy? Again, she implied this isn't the case.

I'd really appreciate some help clearing this up, so what do you guys think? Is my psychiatrist right or are you as dubious as I am?

You have a problem:

Location: Liverpool, UK

That's a problem. Your city, has a PROBLEM:

http://www.cph.org.uk/wp-content/uploads/2017/02/Liverpool-neurodevelopmental-needs-assessment_final-report_Jan17.pdf

You need to talk to a psychiatrist who actually WANTS to diagnose ADHD.

Brooks1138
03-19-17, 04:28 PM
The psychiatrist I met with wasn't actually based in Liverpool, that's just where I go to university :)

You might be right about needing to go to see someone else though, her diagnostic approach didn't seem particularly informed or objective.

Postulate
03-19-17, 04:52 PM
The psychiatrist I met with wasn't actually based in Liverpool, that's just where I go to university :)

You might be right about needing to go to see someone else though, her diagnostic approach didn't seem particularly informed or objective.

No, no, she just sent you for a stroll. She kindly told you to go look for her outside and if you don't find her to stay there. There was no effort on her side and her arguments are laughable at best.

Did you offend her in any way?

dvdnvwls
03-19-17, 05:34 PM
I was never hyperactive; in fact, if anything I was under-active - "bookish", poor at sports, a slow runner, and adults considered me polite and well-behaved from quite a young age.

My ADHD is glaringly obvious to anyone who knows me and reads a list of the symptoms.

Lunacie
03-19-17, 05:44 PM
No, no, she just sent you for a stroll. She kindly told you to go look for her outside and if you don't find her to stay there. There was no effort on her side and her arguments are laughable at best.

Did you offend her in any way?

I doubt that the OP somehow "offended" the psychiatrist. I expect she was in
the NHS ... which is notorious for misdiagnosing and underdiagnosing ADHD in
adults.

Some of our members have had a very rocky road to diagnosis in the U.K. In no
way their fault. Some have gone to psychiatrists in the private sector for help.

Fuzzy12
03-19-17, 07:40 PM
Uggh. Everytime someone posts about a rubbish psychiatrist they always turn out to be in the uk.:mad:

If this was an nhs psychiatrist you might be better off going private though that is no guarantee for quality care either.

Postulate
03-19-17, 08:16 PM
Uggh. Everytime someone posts about a rubbish psychiatrist they always turn out to be in the uk.:mad:

If this was an nhs psychiatrist you might be better off going private though that is no guarantee for quality care either.

It is criminal behaviour that violates any doctor's oath to preserve the well-being of the patient. They shouldn't do it. It's pathetic.

Brooks1138
03-19-17, 09:53 PM
Thanks for the responses everyone! Relieved to hear that the psychiatrist was talking nonsense :) Just to clear things up this was a private assessment, not NHS - my GP's response when I told him about it was along the lines of 'ADHD isn't a big deal, just get plenty of sleep and set reminders for things on your phone and you'll be fine!' Wow, thanks, I'm cured :rolleyes: Besides, I didn't particularly wanna spend up to 2 years on the NHS waiting list. So basically I was given terrible advice and charged a lot for it.


Did you offend her in any way?
Haha no not at all, maybe she just didn't like the look of me?
I've heard a lot about how the UK medical community is mostly useless when it comes to ADHD, I guess now I've experienced it first-hand. We'll see how the follow-up meeting goes, but I think I'm gonna end up needing to seek help elsewhere. It just kinda sucks that it's this difficult; it was hard enough for me to come to terms with the idea of having ADHD and seeking help for it, now I've gotta face a system that seems reluctant to give me any help. But anyway I'm just venting now, hopefully I'll eventually get to see somebody with a head on their shoulders and things will work out :)

Fuzzy12
03-19-17, 10:06 PM
Thanks for the responses everyone! Relieved to hear that the psychiatrist was talking nonsense :) Just to clear things up this was a private assessment, not NHS - my GP's response when I told him about it was along the lines of 'ADHD isn't a big deal, just get plenty of sleep and set reminders for things on your phone and you'll be fine!' Wow, thanks, I'm cured :rolleyes: Besides, I didn't particularly wanna spend up to 2 years on the NHS waiting list. So basically I was given terrible advice and charged a lot for it.



Haha no not at all, maybe she just didn't like the look of me?
I've heard a lot about how the UK medical community is mostly useless when it comes to ADHD, I guess now I've experienced it first-hand. We'll see how the follow-up meeting goes, but I think I'm gonna end up needing to seek help elsewhere. It just kinda sucks that it's this difficult; it was hard enough for me to come to terms with the idea of having ADHD and seeking help for it, now I've gotta face a system that seems reluctant to give me any help. But anyway I'm just venting now, hopefully I'll eventually get to see somebody with a head on their shoulders and things will work out :)

My gp at various appointments:

'Adhd is just something for boys who have dropped out of school'

'You are too intelligent to have adhd'

(After my diagnosis:)
'I can't recommend taking methyl phenidate. It's basically just speed.'

:rolleyes:

And a lot of the psychiatrists I've seen aren't any better.

kilted_scotsman
03-20-17, 05:03 AM
Getting an ADHD diagnosis in the UK is tougher than in the US. Psych's here set the bar significantly higher. It's only a few years since it's been recognised in adults so many diagnosticians aren't familiar with it's presentation in adults.

The focus thing is important..... NT's are able to focus on what they want to focus on, regardless of whether it's enjoyable or not. This is how modern employment works.

ADDers can focus on what they enjoy and find stimulating, unfortunately this is to the exclusion of the many, less enjoyable things that are important to survival in the modern world. In addition we tend to find enjoyment in all sorts of weird and compulsive places, which is the hyperfocus side of things.

Your psych was both right and wrong..... being able to focus on what you enjoy does not contraindicate ADHD, being unable to focus on routine, boring but important tasks in a way that severely impacts life is indicative of ADHD. Not being able to concentrate on university work does NOT indicate ADHD.

Stress reduces the ability to focus in everyone.... NT and ADHD, and University can be a stressful place, particularly if one gets locked into a -ve feedback loop around avoiding studying.

THere's also the issue of moving from school, where the workload is comparatively low and the level of external direction high, to University where the opposite is true. If you were daydreamy in school, but still made Uni, it's likely you've not had to learn to focus, or had to work out what learning style suits you. Most kids work this out at school, Uni is pretty late.... but not uncommon.

In short the psych may be wondering if you've hit your "learning wall" the point at which your innate intelligence isn't enough to carry you through..... highly stressful (thereby reducing focus)....but not ADHD.

Unfortunately your in just the situation where intelligent and well informed students try to get round their studying issues through pharmacology..... and psychs are well aware of this, since they've been through Uni and know the score.

RE Postulate's PDF, it doesn't say that Liverpool, doesn't diagnose ADHD, it says that Liverpool is the same as the majority of England in having issues with mental health diagnosis and support.

tearsong
03-20-17, 07:29 AM
Unfortunately your in just the situation where intelligent and well informed students try to get round their studying issues through pharmacology..... and psychs are well aware of this, since they've been through Uni and know the score.

Unfortunately, this is often the reason that twice exceptional students (those with gifts/talents AND 1+ disabilities) are often missed.

1) They are able to compensate for the disability to a point - which means they appear to not have a disability at all until things get too difficult (this wall is different for everyone, and they may be identified as gifted-only or as an "average" student, without gifts OR disabilities);

2) They are unable to display their gifts due to the disability, and may be identified as requiring special education only...

Secondarily, do they just not do neuropsych testing to diagnose ADHD in the UK?

Brooks1138
03-20-17, 11:35 AM
Getting an ADHD diagnosis in the UK is tougher than in the US. Psych's here set the bar significantly higher. It's only a few years since it's been recognised in adults so many diagnosticians aren't familiar with it's presentation in adults.

The focus thing is important..... NT's are able to focus on what they want to focus on, regardless of whether it's enjoyable or not. This is how modern employment works.

ADDers can focus on what they enjoy and find stimulating, unfortunately this is to the exclusion of the many, less enjoyable things that are important to survival in the modern world. In addition we tend to find enjoyment in all sorts of weird and compulsive places, which is the hyperfocus side of things.

Your psych was both right and wrong..... being able to focus on what you enjoy does not contraindicate ADHD, being unable to focus on routine, boring but important tasks in a way that severely impacts life is indicative of ADHD. Not being able to concentrate on university work does NOT indicate ADHD.

Stress reduces the ability to focus in everyone.... NT and ADHD, and University can be a stressful place, particularly if one gets locked into a -ve feedback loop around avoiding studying.

THere's also the issue of moving from school, where the workload is comparatively low and the level of external direction high, to University where the opposite is true. If you were daydreamy in school, but still made Uni, it's likely you've not had to learn to focus, or had to work out what learning style suits you. Most kids work this out at school, Uni is pretty late.... but not uncommon.

In short the psych may be wondering if you've hit your "learning wall" the point at which your innate intelligence isn't enough to carry you through..... highly stressful (thereby reducing focus)....but not ADHD.

Unfortunately your in just the situation where intelligent and well informed students try to get round their studying issues through pharmacology..... and psychs are well aware of this, since they've been through Uni and know the score.

RE Postulate's PDF, it doesn't say that Liverpool, doesn't diagnose ADHD, it says that Liverpool is the same as the majority of England in having issues with mental health diagnosis and support.

You're definitely right about that last part, as soon as I mentioned I frequently struggle to get uni work done on time it seemed like that's all the psych wanted to talk about, like I'm just trying to get hopped up on free study pills or something. Truth is uni is just one relatively small part of the issue (I'm still on track to pass with a 2:1). Stuff like the guilt I feel about the fact that I frequently let friends down by forgetting about or turning up late to plans we've made, feeling completely and utterly inept because I'm unable to get even the most basic of tasks done (either because I forget or because my brain just rejects the idea of doing something mundane), and a thousand other things which are probably linked to the on/off depression I've been experiencing since I was 15, that's the stuff I wanted to address. But basically I think the fact I'm young and at university immediately made her think I was talking a load of bull****.

userguide
03-22-17, 01:02 PM
Can't you guys in the UK make a blog with psychs that don't read DSMs ?

That should make them see how much profit they lose if they're "blacklisted" for negligence.

Lunacie
03-22-17, 01:40 PM
Can't you guys in the UK make a blog with psychs that don't read DSMs ?

That should make them see how much profit they lose if they're "blacklisted" for negligence.

I seem to remember reading that the NHS in the U.K. uses a different manual
than the DSM.

Some doctors in the U.S. still don't accept that kids don't "grow out of" ADHD.
That's even more common in the U.K.

Johnny Slick
03-22-17, 03:17 PM
The psychiatrist I met with wasn't actually based in Liverpool, that's just where I go to university :)

You might be right about needing to go to see someone else though, her diagnostic approach didn't seem particularly informed or objective.I think the point is that the UK and the NHS in particular has developed something of a... reputation for underdiagnosing ADHD and the inattentive strain in particular.

That really, really sucks, man. Even if you can't get medication, can you carry on assuming that you do in fact have ADHD and, I don't know, try and seek other methods of dealing with this (like support groups or bluish-tinted message boards)?

mischaelman
03-23-17, 09:27 PM
Unfortunately, this is often the reason that twice exceptional students (those with gifts/talents AND 1+ disabilities) are often missed.

1) They are able to compensate for the disability to a point - which means they appear to not have a disability at all until things get too difficult (this wall is different for everyone, and they may be identified as gifted-only or as an "average" student, without gifts OR disabilities);

2) They are unable to display their gifts due to the disability, and may be identified as requiring special education only...

Secondarily, do they just not do neuropsych testing to diagnose ADHD in the UK?

This is what happened with me. Even with being diagnosed in the U.S. and after neuropsych testing I've had major challenges because of being twice exceptional.

I hope you're able to find the right doctor who listens to your concerns with an open mind.

I remember how miserable it to be a university student struggling with procrastinating on papers, etc. This was one of the problems that eventually led to my diagnosis.

tearsong
04-02-17, 04:43 AM
I seem to remember reading that the NHS in the U.K. uses a different manual than the DSM.

They use the International Classification of Diseases (ICD) (https://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseas es_and_Related_Health_Problems), I believe.

That said, the two aren't drastically different, I don't think. The ICD is bit less on the "checkbox-y" side than the DSM, I suppose.

(The the most recent published version of the ICD 10 (in PDF) descriptions & diagnostic guidelines (www.who.int/classifications/icd/en/bluebook.pdf), pgs. 206-209 is pasted below, as a comparison to the DSM-V ADHD criteria (https://www.addrc.org/dsm-5-criteria-for-adhd/) that you're probably familiar with.)

------------------------------------
F90 Hyperkinetic disorders

This group of disorders is characterized by: early onset; a combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement; and pervasiveness over situations and persistence over time of these behavioural characteristics.

It is widely thought that constitutional abnormalities play a crucial role in the genesis of these disorders, but knowledge on specific etiology is lacking at present.

In recent years the use of the diagnostic term "attention deficit disorder" for these syndromes has been promoted. It has not been used here because it implies a knowledge of psychological processes that is not yet available, and it suggests the inclusion of anxious, preoccupied, or "dreamy" apathetic children whose problems are probably different. However, it is clear that, from the point of view of behaviour, problems of inattention constitute a central feature of these hyperkinetic syndromes.

Hyperkinetic disorders always arise early in development (usually in the first 5 years of life). Their chief characteristics are lack of persistence in activities that require cognitive involvement, and a tendency to move from one activity to another without completing any one, together with disorganized, ill regulated, and excessive activity. These problems usually persist through school years and even into adult life, but many affected individuals show a gradual improvement in activity and attention.

Several other abnormalities may be associated with these disorders. Hyperkinetic children are often reckless and impulsive, prone to accidents, and find themselves in disciplinary trouble because of unthinking (rather than deliberately defiant) breaches of rules. Their relationships with adults are often socially disinhibited, with a lack of normal caution and reserve; they are unpopular with other children and may become isolated. Cognitive impairment is common, and specific delays in motor and language development are disproportionately frequent.

Secondary complications include dissocial behaviour and low self esteem. There is accordingly considerable overlap between hyperkinesis and other patterns of disruptive behaviour such as"unsocialized conduct disorder". Nevertheless, current evidence favours the separation of a group in which hyperkinesis is the main problem.

Hyperkinetic disorders are several times more frequent in boys than in girls. Associated reading difficulties (and/or other scholastic problems) are common.

Diagnostic guidelines
The cardinal features are impaired attention and overactivity: both are necessary for the diagnosis and should be evident in more than one situation (e.g. home, classroom, clinic).

Impaired attention is manifested by prematurely breaking off from tasks and leaving activities unfinished. The children change frequently from one activity to another, seemingly losing interest in one task because they become diverted to another (although laboratory studies do not generally show an unusual degree of sensory or perceptual distractibility). These deficits in persistence and attention should be diagnosed only if they are excessive for the child's age and IQ.

Overactivity implies excessive restlessness, especially in situations requiring relative calm. It may, depending upon the situation, involve the child running and jumping around, getting up from a seat when he or she was supposed to remain seated, excessive talkativeness and noisiness, or fidgeting and wriggling. The standard for judgement should be that the activity is excessive in the context of what is expected in the situation and by comparison with other children of the same age and IQ. This behavioural feature is most evident in structured, organized situations that require a high degree of behavioural self-control.

The associated features are not sufficient for the diagnosis or even necessary, but help to sustain it. Disinhibition in social relationships, recklessness in situations involving some danger, and impulsive flouting of social rules (as shown by intruding on or interrupting others' activities, prematurely answering questions before they have been completed, or difficulty in waiting turns) are all characteristic of children with this disorder.

Learning disorders and motor clumsiness occur with undue frequency, and should be noted separately (under F80-F89) when present; they should not, however, be part of the actual diagnosis of hyperkinetic disorder. Symptoms of conduct disorder are neither exclusion nor inclusion criteria for the main diagnosis, but their presence or absence constitutes the basis for the main subdivision of the disorder (see below).

The characteristic behaviour problems should be of early onset (before age 6 years) and long duration. However, before the age of school entry, hyperactivity is difficult to recognize because of the wide normal variation: only extreme levels should lead to a diagnosis in preschool children.

Diagnosis of hyperkinetic disorder can still be made in adult life. The grounds are the same, but attention and activity must be judged with reference to developmentally appropriate norms. When hyperkinesis was present in childhood, but has disappeared and been succeeded by another condition, such as dissocial personality disorder or substance abuse, the current condition rather than the earlier one is coded.

Differential diagnosis. Mixed disorders are common, and pervasive developmental disorders take precedence when they are present. The major problems in diagnosis lie in differentiation from conduct disorder: when its criteria are met, hyperkinetic disorder is diagnosed with priority over conduct disorder. However, milder degrees of overactivity and inattention are common in conduct disorder. When features of both hyperactivity and conduct disorder are present, and the hyperactivity is pervasive and severe, "hyperkinetic conduct disorder" (F90.1) should be the diagnosis.

A further problem stems from the fact that overactivity and inattention, of a rather different kind from that which is characteristic of a hyperkinetic disorder, may arise as a symptom of anxiety or depressive disorders. Thus, the restlessness that is typically part of an agitated depressive disorder should not lead to a diagnosis of a hyperkinetic disorder. Equally, the restlessness that is often part of severe anxiety should not lead to the diagnosis of a hyperkinetic disorder. If the criteria for one of the anxiety disorders (F40.-, F41.-, F43.-, or F93.-) are met, this should take precedence over hyperkinetic disorder unless there is evidence, apart from the restlessness associated with anxiety, for the additional presence of a hyperkinetic disorder. Similarly, if the criteria for a mood disorder (F30-F39) are met, hyperkinetic disorder should not be diagnosed in addition simply because concentration is impaired and there is psychomotor agitation. The double diagnosis should be made only when symptoms that are not simply part of the mood disturbance clearly indicate the separate presence of a hyperkinetic disorder. Acute onset of hyperactive behaviour in a child of school age is more probably due to some type of reactive disorder (psychogenic or organic), manic state, schizophrenia, or neurological disease (e.g. rheumatic fever).

Excludes: anxiety disorders (F41.- or F93.0)
mood [affective] disorders (F30-F39)
pervasive developmental disorders (F84.-)
schizophrenia (F20.-)

F90.0 Disturbance of activity and attention
There is continuing uncertainty over the most satisfactory subdivision of hyperkinetic disorders. However, follow-up studies show that the outcome in adolescence and adult life is much influenced by whether or not there is associated aggression, delinquency, or dissocial behaviour. Accordingly, the main subdivision is made according to the presence or absence of these associated features. The code used should be F90.0 when the overall criteria for hyperkinetic disorder (F90.-) are met but those for F91.- (conduct disorders) are not.

Includes: attention deficit disorder or syndrome with hyperactivity attention deficit hyperactivity disorder

Excludes: hyperkinetic disorder associated with conduct disorder (F90.1)

F90.1 Hyperkinetic conduct disorder
This coding should be used when both the overall criteria for hyperkinetic
disorders (F90.-) and the overall criteria for conduct disorders (F91.-) are met.

F90.8 Other hyperkinetic disorders

F90.9 Hyperkinetic disorder, unspecified

This residual category is not recommended and should be used only when there is a lack of differentiation between F90.0 and F90.1 but the overall criteria for F90.- are fulfilled.

Includes: hyperkinetic reaction or syndrome of childhood or adolescence NOS

Fuzzy12
04-02-17, 06:40 AM
The nhs psychiatrist I first saw told me they use the dsm as well. Anyway I think adhd is diagnosed based on a detailed interview that covers the dsm (or icd) symptoms and more and in more detail. I don't they restrict (or should restrict) themselves to just the dsm or icd. If th did you wouldn't really need a psychiatrist.

sarahsweets
04-05-17, 04:37 AM
I had to look up what hyperkinetic meant, here is something I found:

Though the American Psychiatric Association's criteria for attention deficit hyperactivity disorder (ADHD), and the World Health Organization's criteria for hyperkinetic disorder each list a very similar set of 18 symptoms, the differing rules governing diagnosis mean that hyperkinetic disorder features greater impairment and more impulse-control difficulties than typical ADHD, and it most resembles a severe case of ADHD combined type.[1]
Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms (rather than relying only on parent and teacher reports); that onset must be by age 6 not 7;[3] and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings. While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder.[1] Most cases of hyperkinetic disorder appear to meet the broader criteria of ADHD.[4]
Hyperkinetic disorder may exist comorbid with conduct disorder, in which case the diagnosis is hyperkinetic conduct disorder.[1]

Lunacie
04-05-17, 11:49 AM
While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder.

That is soooo confusing to me. Anyone else understand it?

namazu
04-05-17, 11:53 AM
That is soooo confusing to me. Anyone else understand it?
I think it's saying:

According to the DSM criteria, you can be diagnosed with ADHD and bipolar disorder or major depressive disorder or anxiety disorder at the same time.

According to the WHO criteria, a diagnosis of mania or depression or anxiety disorder preempts/precludes diagnosis of hyperkinetic disorder. (Kind of like how an autism diagnosis used to "supersede" ADHD according to old DSM criteria.)

Different sets of criteria.

(I don't know if this is current, though it may be -- Sarah, what was the source for your quote?)

Lunacie
04-05-17, 11:57 AM
I think it's saying:

According to the DSM criteria, you can be diagnosed with ADHD and bipolar disorder or major depressive disorder or anxiety disorder at the same time.

According to the WHO criteria, a diagnosis of mania or depression or anxiety disorder preempts/precludes diagnosis of hyperkinetic disorder. (Kind of like how an autism diagnosis used to "supersede" ADHD according to old DSM criteria.)

Different sets of criteria.

(I don't know if this is current, though it may be -- Sarah, what was the source for your quote?)

Okay, I thought that might be it, but it was worded very poorly.

namazu
04-05-17, 12:09 PM
Okay, I thought that might be it, but it was worded very poorly.
I agree! :)

sarahsweets
04-06-17, 04:25 AM
Ill admit it was the first hit from wikipedia when I googled.

I think it's saying:

According to the DSM criteria, you can be diagnosed with ADHD and bipolar disorder or major depressive disorder or anxiety disorder at the same time.

According to the WHO criteria, a diagnosis of mania or depression or anxiety disorder preempts/precludes diagnosis of hyperkinetic disorder. (Kind of like how an autism diagnosis used to "supersede" ADHD according to old DSM criteria.)

Different sets of criteria.

(I don't know if this is current, though it may be -- Sarah, what was the source for your quote?)