Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that typically appears in childhood and can persist into adulthood. The core symptoms of ADHD include inattention, hyperactivity, and impulsivity.
Inattention
Inattention is one of the hallmark symptoms of ADHD. Individuals with ADHD struggle with sustained focus and attention, as well as organization and time management. Some specific signs of inattention include:
- Difficulty paying close attention to details or making careless mistakes
- Problems sustaining attention in tasks or play activities
- Not seeming to listen when spoken to directly
- Failing to follow through on instructions or finish tasks
- Difficulty organizing tasks and activities
- Avoidance or dislike of tasks requiring sustained mental effort (such as homework)
- Often losing things necessary for tasks
- Easily distracted by external stimuli
- Forgetfulness in daily activities
Inattention is often one of the most impairing aspects of ADHD. It can significantly impact academic performance, work productivity, and the ability to effectively manage daily responsibilities. Individuals with predominantly inattentive ADHD often have a history of academic underachievement and workplace difficulties.
Hyperactivity
Hyperactivity refers to excessive motor activity and restlessness. Individuals with hyperactive symptoms of ADHD display excessive fidgeting, tapping, talking, and difficulty staying seated in calm situations. Hyperactivity is often more pronounced in childhood, and may manifest as:
- Squirming in seats or tapping hands/feet excessively
- Difficulty staying seated or playing quietly
- Excessive talking or interrupting others
- Trouble staying on-task during seated activities
- Heightened and seemingly constant motion or activity
- Restlessness even during sleep
Hyperactivity tends to decline with age, though restlessness and fidgeting often persist into adulthood. Hyperactivity can impede learning in school-aged children and disrupt workplace behavior in adults.
Impulsivity
Impulsivity refers to hasty actions without forethought or regard for consequences. Individuals with ADHD may display poor impulse control and excessive risk-taking behaviors. Signs of impulsivity include:
- Blurting out answers before questions have been completed
- Difficulty waiting turns or patience in general
- Interrupting or intruding on others’ activities or conversations
- Making important decisions on the spur of the moment
- Engagement in high-risk behaviors
- Low frustration tolerance
- Frequent mood swings or hot temper
Impulsivity can lead to accidents, interpersonal conflicts, substance abuse, and other adverse outcomes. It may decline with maturation but remains problematic for many adults with ADHD.
Other Common Symptoms
In addition to the core symptoms, ADHD is associated with other difficulties including:
- Learning disabilities
- Sleep disorders
- Low self-esteem
- Chronic boredom or feelings of inner-restlessness
- Problems with regulating emotions
- Trouble coping with stress or change
These additional symptoms and challenges can greatly impact day-to-day living for individuals with ADHD across settings.
ADHD Presentations
There are three main clinical presentations of ADHD based on the predominant symptoms exhibited:
- Predominantly inattentive presentation – characterized by significant inattention with fewer symptoms of hyperactivity/impulsivity
- Predominantly hyperactive-impulsive presentation – characterized by significant hyperactivity and impulsivity with fewer symptoms of inattention
- Combined presentation – characterized by high levels of inattention, hyperactivity, and impulsivity
Although the inattentive presentation is most common, any presentation can significantly impair functioning. The symptoms displayed depend on factors like age, comorbid disorders, and environmental stressors.
ADHD Symptoms in Children vs. Adults
While the core symptoms of ADHD often persist from childhood into adulthood, there are some age-related differences in manifestation:
| Children | Adults |
|---|---|
| Constant motion and “on the go” behavior | Restlessness and difficulty relaxing |
| Impulsive blurting out in class | Impulsive behaviors like substance abuse or excessive spending |
| Highly distracted during storytime | Difficulty focusing during meetings and conversations |
| Fidgeting and difficulty remaining seated | Fidgeting and restlessness |
| Interrupting others frequently | Impatience and difficulty waiting turns |
| Forgets to turn in homework | Poor organization and forgetfulness |
While hyperactivity tends to improve with age, challenges with inattention, impulsivity, and disorganization often persist from childhood into adulthood.
ADHD and Comorbid Conditions
ADHD commonly co-occurs with other neurodevelopmental, mental health, and learning disorders. Some conditions that are more prevalent among those with ADHD include:
- Oppositional defiant disorder
- Conduct disorder
- Anxiety disorders
- Depressive disorders
- Substance use disorders
- Learning disabilities
- Sleep disorders
The presence of comorbid disorders can exacerbate ADHD symptoms and lead to greater functional impairment. Comprehensive assessment, diagnosis, and treatment of any coexisting conditions are important.
Causes and Risk Factors
The exact causes of ADHD are not fully known, but research suggests a complex interaction between genetic, biological, and environmental factors. Contributing factors may include:
- Genetics – ADHD tends to run in families and heritability rates are quite high. Specific genes involved in dopamine and norepinephrine activity have been implicated.
- Neurobiology – Imbalances or deficiencies in dopamine, norepinephrine, and serotonin neurotransmission are thought contribute to ADHD.
- Brain structure/function – Structural or connectivity differences in certain brain regions associated with attention, behavior control, and reward processing have been found.
- Prenatal and perinatal problems – Exposure to toxins, maternal stress or substance use during pregnancy may increase risk.
- Brain injury – A traumatic brain injury may increase risk in some cases.
- Environmental exposures – Exposure to high levels of toxins like lead may play a role.
While these factors can increase risk, they do not always directly cause ADHD. Ongoing research is illuminating the intricate interplay between risk factors and neurodevelopmental processes underlying ADHD.
Assessment and Diagnosis
A clinical evaluation by a mental health professional is required to assess for ADHD. The evaluation typically involves:
- Physical exam and medical history review
- Interviews with the individual and close others
- ADHD symptom questionnaires
- Cognitive and achievement testing
- Developmental and psychosocial history
- Screening for co-occurring conditions
Information is gathered from multiple sources to identify ADHD symptoms and related impairments across settings. Diagnosis is based on the ongoing presentation of developmentally inappropriate levels of inattention, hyperactivity, and impulsivity that impair functioning.
ADHD Treatment
ADHD is typically treated with a combination of behavior therapy and medication. Common treatments include:
- Stimulant medications – Stimulants like methylphenidate (Ritalin) and amphetamines (Adderall) are first-line pharmacological treatments that help increase focus and attention while decreasing impulsivity and hyperactivity in the majority individuals.
- Non-stimulant medications – Non-stimulant medications like atomoxetine and guanfacine are alternatives for those who don’t tolerate stimulants well or need additional treatment.
- Behavioral interventions – Behavior therapy helps develop strategies, routines, and skills to manage ADHD symptoms and thrive across settings. Parent training is also important.
- School/workplace accommodations – Accommodations like extended time, modified workspaces, and frequent breaks assist with managing symptoms.
- Lifestyle adjustments – Adjustments to sleep, exercise, diet, stress management, organization, and time management support overall wellbeing.
- Social skills training – Social skills training teaches interpersonal, communication, and coping skills to improve relationships.
- Counseling – Counseling provides support in managing challenges related to ADHD such as low self-esteem and coping with symptoms.
Treatment is tailored the individual’s unique presentation and needs with medication and behavior therapy as the cornerstones for management.
Conclusion
ADHD is characterized by developmentally inappropriate inattention, hyperactivity, and impulsivity that impair functioning. While it often arises in childhood, ADHD frequently persists into adulthood and is a lifelong neurodevelopmental disorder for many. Comprehensive assessment, diagnosis, and an individualized, multimodal treatment approach can significantly improve ADHD symptoms and quality of life. Ongoing research continues to advance our understanding of ADHD’s complex causes and optimal treatments.