Everything You Need To Know About ADHD

Presentations of ADHD

To better comprehend today’s ADHD definition, we can look at the three basic presentations of the condition.

The diagnosed presentation depends on which symptoms are strongest in the individual. As people change over time, their symptoms and type may change as well. The same is true for how severe the condition is.

Predominantly Inattentive Presentation

The person struggles most with attention. They have trouble staying present with a task, organizing it, and finishing it.

They find it difficult to follow instructions, tune into conversations, and focus on details. Creating and maintaining routines is difficult because the person is so easily distracted.

Predominantly Hyperactive-Impulsive Presentation

The condition manifests more physically, with lots of fidgeting and twitching, running and jumping, frenetic movement, or restlessness.

The person may exhibit impulse control issues, such as interrupting, grabbing, or throwing.

Combined Presentation

The combined presentation exhibits an equal distribution of the above symptoms.

Severity Levels of ADHD

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) now requires medical professionals to select a severity level when diagnosing ADHD. This breaks down as follows:

• Mild – The child or adult exhibits only a few of the symptoms required for diagnosis. These symptoms do not present a huge impairment when it comes to school, work, or social life.
• Moderate – More symptoms are present than with a mild case, but less so than with a severe one.
• Severe – The condition creates a significant negative impact on the person who has it. Symptoms result in a high level of impairment in daily life, relationships, school, or work.

Severity levels do change over time, sometimes without warning. The condition may change form as well. Some children grow out of ADHD, while others find that most or all of the symptoms persist.

According to CHADD, those who grow out of childhood ADHD are diagnosed as having “ADHD in partial remission.”

ADHD in Women

According to the DSM-5, ADHD occurs in about 2.5% of adults in most cultures.

ADHD is more common in males than in females at any age.

However, research suggests the gender ratio narrows in ADHD among adults, with 1.6 males for each female with the condition.

As the Cleveland Clinic points out, research indicates that the condition is not necessarily less common in women but instead is underdiagnosed.

In other words, many adult women experience ADHD and can have debilitating symptoms if they don’t get the help they need.

In women, ADHD typically manifests as inattention. Women with ADHD are less likely to have issues with hyperactivity and impulsivity, although these symptoms can still occur.

If you think you or someone you care about may have ADHD, it’s important to push past any barriers to diagnosis.

Signs and Symptoms of ADHD

It’s normal for children to have trouble focusing, keeping their hands to themselves, sitting still, paying attention to details, and remembering routines. If you are just noticing such issues in a developing child, you might want to wait to see if they grow out of them in a few months.

However, if the issues persist over time or the signs of ADHD become worse, it is important to seek the guidance of a mental health professional.

The following list of symptoms applies to child as well as adult ADHD.

Inattention

Signs of inattention include:

• Frequent daydreaming
• Forgetting and losing things
• Making unnecessary mistakes
• Missing details
• Having trouble sustaining attention
• Finding it hard to follow through on instructions or routines
• Not listening when spoken to
• Having trouble with organization
• Avoiding tasks that require effort
• Becoming easily distracted by outside stimuli or inner thoughts
• Hyper-focusing on some activities or interests and having trouble breaking away

Some people assume that inattentive ADHD symptoms only apply to the tasks or routines that people find unpleasant, such as chores, school, work, calls, or errands.

However, ADHD often impacts people during their most relaxed times. They can have symptoms when they try to play games with family members, enjoy downtime, pay attention to a movie, and so on.

Hyperactivity and Impulsivity

Hyperactivity and impulsivity may permeate every area of a child’s life. Signs of hyperactivity and impulsivity include:

• Squirming and fidgeting while seated or standing
• Talking too much or too loudly
• Leaving seat during a time when it’s expected to stay seated
• Finding excuses to move around
• Having trouble taking turns
• Finding it hard to resist temptation
• Cutting people off, interrupting, or predicting others’ thoughts rather than waiting for them to finish
• Looking or feeling restless
• Running and jumping at inappropriate times

Inattention and hyperactivity can combine in countless ways depending on the person, their age, their gender, and other factors.

Dysregulation

Emotional dysregulation isn’t part of the current diagnostic criteria for ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, clinicians and researchers increasingly recognize emotion dysregulation as a core feature of ADHD.

Signs of emotion regulation challenges can include:

• Fast-building, high-intensity, and short-lived emotions
• Emotional reactions that seem out of sync with their cause
• Feeling “overwhelmed” by emotions
• Difficulty recognizing emotions in oneself and others
• Experiencing many more emotions at once than a typical person might
• Difficulty shifting focus away from emotions

Some of these symptoms are developmentally appropriate and normal. However, when they are particularly prominent or the child doesn’t grow out of them, they may be signs of ADHD.

Distinguishing ADHD From Similar Presentations

Getting a diagnosis is often the main concern of a parent who has a child with ADHD, or an adult who is seeking treatment for themselves.

A critical milestone when seeking a diagnosis is to separate the above ADHD symptoms from signs of another condition.

Several conditions present in similar ways to ADHD, which can muddy the waters.

Misdiagnosis is a common problem in children as well as adults. Since misdiagnosis prevents proper treatment, it’s important to know which conditions look similar to ADHD.

According to Healthline, conditions that can be confused with ADHD include:

Bipolar Disorder

This condition also manifests as restlessness, talkativeness, impatience, impulsivity, and outbursts. However, mood shifts are more pronounced with bipolar disorder.

Autism Spectrum Disorder

Similar to children with ADHD, children with autism face social challenges.

While those with autism may have less social awareness of others, those with ADHD often have some degree of awareness, but still struggle to overcome impulses that interfere with social interactions.

Both may dominate conversations, but while individuals with autism may focus extensively on a specific interest, those with ADHD often switch topics frequently during conversation. Each may find that this can make peer interactions tricky.

Sensory Integration Issues

When children have trouble processing sensory input, such as touch or sound, they may present similarly to those with ADHD. Signs of sensory processing issues include trouble focusing, difficulty following directions, and hopping quickly between activities. However, children with sensory integration issues often seem more overwhelmed and less excitable than those with ADHD.

Sleep Disorders

Some children with ADHD may have trouble falling asleep. People with sleep disorders may have difficulty concentrating or staying on task during the day. It can be hard to tease the two conditions apart.

Hearing Loss

When children cannot hear, they cannot follow directions effectively. They may not know they have trouble hearing, or they may try to mask the issue. It is helpful to rule out hearing loss when assessing for ADHD.

Learning Disabilities

When children don’t understand the material being taught or what is being asked of them, they may appear to have ADHD.

Depression and Anxiety

Kids who are sad or anxious may find it hard to concentrate, be present, follow directions, or remember routines. For that reason, any ADHD test should include a screening for these issues.

Substance Misuse

When ADHD symptoms arise later in adolescence, substance use should be considered. Substance misuse can mimic the symptoms of disorganization, trouble concentrating, trouble interacting with peers, and even manic or “hyperactive” behaviors.

ADHD at All Ages

ADHD symptoms may present at all ages. The ADHD assessment for adults is a little different from that for children.

Adults are unlikely to grow out of ADHD symptoms, as some children do. Adults have different environmental demands than children.

ADHD in Children

In kids and teens, ADHD often causes problems in school. An ADHD diagnosis entitles children to certain rights in an educational setting.

If a student has ADHD, and it is shown to impair their learning, they can qualify for special education services under the Individuals With Disabilities Education Act.

Typically, extra support falls under an individualized education program, or IEP. An IEP is a plan that parents set up with teachers and the school district.

An IEP includes services to help children who qualify succeed, such as extra instruction, preferred seating, alternative teaching requirements, or a different curriculum.

If they don’t need special education but could use extra support in the classroom, they may qualify for a Section 504 plan under the Rehabilitation Act of 1973.

Section 504 states that students with disabilities must have the same opportunity to participate in educational programs, services, and activities as their non-disabled peers.

While an IEP provides a required modified curriculum or special education services to those who qualify, 504 plans include accommodations that help students access the general education curriculum. IEPs may also include accommodations similar to those in a 504 Plan.

ADHD in Adults

Adult ADHD symptoms often appear different from those in children. For instance, we do not typically describe adults as “hyper” but rather as “restless” or “stressed out.”

For adults who have been diagnosed with ADHD as children, symptoms often remain the same and require ongoing treatment. For those who have not been diagnosed when younger, it may not occur to them or even their physician to look for the issue.

However, a diagnosis is critical to receiving treatment, such as medication or psychotherapy. It’s important to request tests if you suspect ADHD.

The Genetics of ADHD

Some folks wonder if ADHD is genetic, and the answer is yes. ADHD can run in families. In fact, genetics is a big indicator.

For example, according to the Attention Deficit Disorder Association (ADDA), research indicates that children with siblings who have ADHD are nine times more likely to have the condition than children whose siblings do not have ADHD. Four out of ten parents who have ADHD will have a child with ADHD.

ADDA cautions that while genetics play a role, people should not automatically assume that a child will inherit the condition. The environment can also play a part in whether a child develops the disorder. For example, studies of twins demonstrate that one twin may develop ADHD while the other twin does not.

Given the genetic link, if you’re wondering about an ADHD diagnosis for someone whose family members already have been diagnosed, it’s important to get it checked out.

What Causes ADHD?

While ADHD does have a genetic influence, other factors increase a person’s risk of developing the condition.

According to the CDC, risk factors for ADHD include:

• Traumatic brain injury
• Substance use during pregnancy
• Environmental toxins in pregnancy or early childhood
• Premature birth or low birth weight

Over the decades, many other factors have been incorrectly attributed to causing ADHD.

The Challenge of Diagnosing ADHD

Many people who want to know if they or their child has ADHD seek an ADHD test. This is understandable, but there are many factors to consider when looking for an ADHD assessment.

For example, ADHD is a collection of symptoms that we all have at times. Most of us can relate to experiencing distraction, difficulty concentrating, trouble interacting with peers, and hyperactivity. It is only when these symptoms come together and cause significant difficulty in one or more areas of life that they are considered ADHD.

The general requirement for diagnosis is that a person’s symptoms fall into at least one of the following categories:

• Chronic or long-lasting
• Impairing functioning
• Causing a person to fall behind in work, school, or other areas of life

Most people receive an ADHD diagnosis during elementary school. If you or a loved one is seeking an ADHD diagnosis in adolescence or adulthood, your symptoms must have been present since before the age of 12 to qualify. If symptoms appear after age 12, then the condition is likely another that can present as ADHD.

Because so many factors are involved in an ADHD diagnosis, there isn’t one single “ADHD test.” Instead, an individual should get a comprehensive evaluation that rules out other conditions, considers family history, checks health and social factors, and assesses symptoms since childhood.

Psychologists, psychiatrists, doctors, nurses, nurse practitioners, and pediatricians can all provide this evaluation.

Treatment for ADHD

Treatment for ADHD is not only possible, but also widely available and highly effective. Although there is no cure for ADHD, psychotherapy and medication can bring about significant changes in a person’s functioning at school, work, home, and with others.

Psychotherapy

Either in combination with medication or alone, psychotherapy may provide relief from ADHD symptoms. Therapy for ADHD can include, but is not limited to:

• Behavioral therapy – This fundamental therapy helps a child or adult recognize behavioral triggers and find better responses to them. It can help with emotional reactions, organization, and attention.
• Parenting skills training – Sometimes, parents need a leg up when it comes to helping their child succeed in the face of an ADHD diagnosis. Without the right tools to help kids, parents may not be able to provide compassionate, loving care and cheerleading. Skills training can help.
• Family therapy – Life at home often becomes frustrating for a family before a child gets a diagnosis and may remain so afterward. Family therapy can help address built-up tension and return the home to a more pleasant state.
• Classroom interventions – Children with an IEP or 504 plan may qualify for additional help in the classroom. An IEP or 504 plan can help kids modify their behavior, stay on task, get preferential seating, reduce academic requirements to manageable levels, and provide more time for tests.
• Stress management – Although stress does not cause ADHD, it may make it worse. Therapy approaches that help children and adults process stress effectively can help them manage ADHD symptoms.
• Support groups – ADHD is difficult, and it’s often a relief to have somewhere to turn. Support groups exist for both ADHD-diagnosed individuals and their families.

Medication

Many individuals with ADHD benefit from medications that limit impulsivity, improve focus, and heighten their ability to take in information and follow directions. Medications come in two basic classes:

• Stimulants – Stimulants are the most commonly recommended medication to address ADHD. It may seem counterintuitive to prescribe a stimulant to someone who is hyper and unfocused. However, these medications increase the vital neurotransmitters dopamine and norepinephrine. As a result, the brain’s ability to think and focus improves.
• Non-stimulants – For some individuals, stimulants might not be the right fit. If a person negatively reacts to stimulants and shows no improvement with stimulants, non-stimulants can be effective alternatives. In some cases, a combination can be effective. For example, suppose an individual can’t tolerate the side effects of a high enough dose of a stimulant medication to be effective. In that case, a lower dose combined with a non-stimulant can help achieve the desired effect while minimizing side effects.

Depending on coexisting conditions, medical professionals may prescribe other medications to children and adults with ADHD, such as antidepressants. Typically, though, these are not used to treat ADHD directly.

Destigmatizing ADHD

Unfortunately, ADHD has accrued stigma. Many people don’t want their children labeled as having ADHD. Others believe ADHD is a problem invented by the modern age that simply masks how active, dreamy, or undeveloped children naturally are.

It’s important to understand the difference between normal developmental phases and an actual condition. In cases where ADHD symptoms go beyond typical childhood distractions and create true impairment, it is critical to fight stigma. First, we have to recognize it.

Stigmatization may look like:

• Denying symptoms exist
• Believing someone is a troublemaker or just “likes being the class clown”
• Labeling children as slow or daydreamers
• Doubling down on discipline rather than seeking help
• Undermining family members who are trying to get appropriate help
• Refusing to grant or use educational supports, such as an IEP
• Guilting a child or partner about their symptoms

According to CHADD, inequitable rates of diagnosis and treatment are more likely to impact children of color, whose adult caregivers, teachers, and clinicians are more likely to link symptoms to behavioral problems than to pursue a diagnosis for ADHD. The organization points out that because of such stigma, rates of diagnosis are higher for white children than for children of color.

It is also important to remember the deep and often traumatic history between people of color and the medical community. An understanding of historical trauma must inform ADHD treatment to minimize further harm.

Fighting stigma looks like:

• Believing someone when they say they cannot focus
• Understanding that hyperactivity and other behaviors are beyond the person’s control
• Embracing rather than fearing a label
• Providing appropriate support in learning or work environments
• Actively addressing bias in diagnosis and treatment