What are the signs and symptoms of ADHD or Attention Deficit/Hyperactivity Disorder?
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed neurodevelopmental disorders in the United States. Population surveys show that ADHD occurs in most cultures in about 5% of children and 2.5% of adults. There is a prevailing sentiment amongst medical professionals that ADHD is overdiagnosed. I don’t plan on weighing in on that debate, but I do want to talk about what ADHD is and what it is not.
What exactly is ADHD?
Attention Deficit/Hyperactivity Disorder falls under the category of neurodevelopmental conditions. This indicates that ADHD generally manifests during the developmental period, and symptoms are often observed before the child enters grade school. In addition, ADHD can cause deficits in the child’s ability to function in personal, social, and academic domains. ADHD is defined by impaired levels of inattention/disorganization and/or hyperactivity/impulsivity. The older practice of using ‘ADD’ and ‘ADHD’ as separate labels for the inattentive versus hyperactive forms has been retired. In its place, the disorder is now grouped into three types. Deficits in attention and organization define the Inattentive Type; the Hyperactivity/Impulsive Type is defined by hyperactive and impulsive symptoms; and the Combined Type is defined by both Inattention and Hyperactivity/Impulsivity symptoms. To diagnose ADHD and the various subtypes of ADHD, an individual must display a certain number of signs and symptoms within these categories. Below are the signs and symptoms of ADHD, including Inattention and Hyperactivity/Impulsivity that a child must display (according to the diagnostic criteria of the DSM-5) in order to receive a diagnosis of ADHD.
Inattention types:
- Misses details and makes hasty mistakes in work or activities
- Struggles to keep focus during tasks or play
- Appears not to be listening even during direct conversation
- Has trouble completing tasks or following directions through to the end
- Finds it hard to organize tasks and activities
- Puts off or resists activities that demand prolonged mental focus
- Frequently misplaces items needed for tasks/activities
- Easily distracted (including stray thoughts)
- Tends to forget routine daily tasks
Hyperactivity and Impulsivity type:
- Fidgets with or taps hands or feet, squirms in seat
- Gets up and leaves their seat in situations when remaining seated is expected
- Frequently feels restless or full of energy
- Has difficulty engaging in quiet, leisurely activities
- Is “on-the-go” or acts as if “driven by a motor”
- Talks excessively
- Blurts out answers
- Has difficulty waiting their turn
- Cuts in on or intrudes into others’ conversations or activities
How is ADHD diagnosed?
An individual must display six or more symptoms of inattention to be diagnosed with the Inattention Subtype of ADHD, and an individual must display six or more symptoms of hyperactive/impulsive behaviors to be diagnosed with the Hyperactive/Impulsive Subtype. If someone meets the symptom threshold for both Inattention and Hyperactive/Impulsive Subtypes, then they can be diagnosed with the Combined Subtype. To reinforce what I mentioned earlier, these signs and symptoms of ADHD must cause impairment in daily functioning or development in order to meet the criteria for this disorder. In addition, several symptoms must be present before age 12 and in two or more settings (e.g., home and school). For example, if the symptoms only occur at home and in no other setting, a child may not meet the criteria for ADHD.
How do ADHD symptoms change with age?
Signs and symptoms of ADHD are often observed when the individual is a toddler, although they can be difficult to distinguish from the typical developing behavior of a toddler. Because of this, ADHD is usually easier to identify during the school-age years, when symptoms of inattention and hyperactivity/impulsivity begin to affect a child’s ability to function effectively at school. Symptoms of ADHD are relatively stable in early adolescence, although hyperactive behavior generally becomes less pronounced in late adolescence and adulthood. Many people state that children tend to “grow out of ADHD” as they become adults. However, studies have shown that a substantial proportion of children diagnosed with ADHD continue to experience these symptoms into adulthood.
What causes ADHD?
There is no single smoking gun behind ADHD, though research has identified that both environmental and genetic factors play a role in the development of Attention Deficit/Hyperactivity Disorder. It’s also worth noting that several other disorders share features with ADHD but shouldn’t automatically be treated as signs and symptoms of ADHD themselves. A child might, for instance, not pay attention in class because of oppositional and defiant behavior. Or a child may act impulsively at times in the form of an intense behavioral disruption that is out of proportion to the stressor that triggered it, as opposed to the more consistent pattern of impulsive behavior seen in ADHD. Beyond that, several other behavioral and neurodevelopmental conditions that contribute to symptoms of inattention and hyperactive/impulsive behavior. Examples can include Autism Spectrum Disorder, Specific Learning Disorder, Intellectual Disability, Reactive Attachment Disorder, Anxiety Disorders, Depressive Disorders, Bipolar Disorder, Disruptive Mood Dysregulation Disorder, Substance Use Disorders, Personality Disorders, Psychotic Disorders, Medication-Induced Disorders, and Neurocognitive Disorders. Given the multitude of disorders that might present similarly to ADHD, an accurate assessment is needed in order to clarify the diagnostic picture. Thus, a psychological evaluation can be conducted to assess the presence of various symptoms and determine which disorder(s) are responsible for the child’s behavioral presentation.
