The hallmark symptoms of ADHD are hyperactivity, impulsivity and inattentiveness. A formal list is outlined in the fourth edition of the American Psychological Association’s Diagnostic Statistical Manual of Mental Disorders (DSM-IV). That said symptoms can vary considerably from person to person and are dependant upon age, gender, genetics and environmental circumstances.
What are the Symptoms of ADHD?
ADHD symptoms fluctuate. In this way, ADHD resembles depression. From time to time, everyone can feel forgetful, distracted or impulsive just as anyone can feel depressed. What sets someone with ADHD apart from people without the disorder is the consistency and severity of symptoms.
Per the DSM-IV
The DSM-IV divides the symptoms for ADHD into two categories: predominantly inattentive and predominantly hyperactive-impulsive. The symptoms must appear before age 7 and should be present in more than one environment (i.e., home and school). To receive a diagnosis, six or more symptoms must be observed for six months in one or both categories. (An individual with symptoms from each category receives a diagnosis of “combined type.”) The symptoms of each are described below as listed in the DSM-IV1:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities;
- Often has difficulties sustaining attention in tasks or play activities;
- Often does not seem to listen when spoken to directly;
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in school or in the workplace;
- Often has difficulty organizing tasks and activities;
- Often avoids, dislikes or is reluctant to engage in tasks that required sustained mental attention effort;
- Often loses things necessary for tasks or responsibilities;
- Is easily distracted by external stimuli; and
- Is often forgetful in daily activities.
- Often fidgets with hands or feet or squirms in seat;
- Often leaves seat in classroom or in other situations in which remaining seated is expected;
- Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents and adults, may be limited to subjective feelings of restlessness);
- Is often “on the go” or often acts as if “driven by a motor;”
- Often talks excessively;
- Often blurts out answers before questions have been completed;
- Often has difficulty awaiting turn; and
- Often interrupts or intrudes on others.
ADHD Over A Lifetime
The symptoms of ADHD vary over the course of the person’s life. Though roughly 40 percent of children will grow out of the disorder, others will continue to exhibit symptoms into adulthood. It is also possible for an individual to be diagnosed in adulthood. The reason for this is two-fold. As individuals age, they are faced with increasingly responsibilities while having to manage more on their own. For example, in elementary school children usually have just one teacher whereas in middle school, it’s not uncommon for them to have six or more. In high school, students often have the added responsibilities of part-time jobs, driving and writing their college applications. Below is a list of behavioral-oriented problems associated with childhood, adolescence and adulthood.2
- Higher risk of injury
- Reckless; restless
- Incapable of “waiting a moment”
- Resistant to parental intervention
- Easily side-tracked
- Difficulty listening/understanding others
- Difficulty communicating ideas/having others understand them
- Greater risk of associated learning disabilities, especially in reading, math and writing
- Difficulty in managing time
- Difficulty in managing emotions related to physical changes in puberty and/or emerging sexuality
- Greater risk of giving up on academic pursuits as they become increasingly more difficult
- Challenges around operating a car
- Increased anxiety around leaving home
- Difficulty in living more independently
- Higher risk of dropping out of college
- More likely to struggle with making decisions due to the inability to narrow down choices
- Incapable of settling on one job and/or one partner
- Greater risk of mouthing off at work leading to a higher risk of being fired
- Easily overwhelmed by household responsibilities (financing, cleaning, etc.)
- Difficulty in balance the demands of work and family
- More likely to struggle in intimate relationships
Individuals with ADHD are six times more likely to have another psychiatric disorder. “ADHD has extraordinarily high rates of comorbidity with virtually every other psychiatric disorder listed in the DSM-IV,” Brown states in the Attention Deficit Disorder: The Unfocused Mind in Children and Adults. (Comorbidity is when two disorders are present at once.) Children with ADHD are at a greater risk of the following conditions:
In addition, children with ADHD are two to three times more likely to have a learning disability such as reading disorder, mathematics disorder or written expression disorder. Some believe that some of the symptoms of ADHD such as impaired memory may contribute to learning disorders.
Similarly, adults with ADHD are at a greater risk of also suffering from anxiety, mood disorder, impulsive disorder or psychiatric disorder in addition to be more likely to abuse substances such as drugs and alcohol.
Other disorders associated with ADHD include language disorders, PTSD, bipolar disorder, obsessive compulsive disorder and Tourette’s syndrome.3
New guidelines proposed for ADHD
The DSM-V, the fifth edition of the American Psychological Association’s diagnostic manual, is considering a revision to the current criteria for ADHD. Slated for a 2013 release, the new edition would either eliminate the different subtypes by grouping all the symptoms together or creating two separate diagnoses, ADHD, and attention-deficit disorder (ADD). Individuals exhibiting all the symptoms of ADHD with the exception of hyperactivity would receive an ADD diagnosis. The DSM-V is also considering increasing the age before which symptoms must appear from 7 to 12. This would presumably make it easier for more children to be diagnosed with the disorder. Finally, a third consideration is lowering the number of symptoms for adult ADHD. This idea was raised in response to research studies that showed that children exhibit fewer and fewer symptoms as they age.4
- American Psychiatric Association,* Diagnostic Statistical Manual of Mental Disorders*, Fourth Edition. Washington, D.C.: American Psychiatric Association, 1994.
- Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 20–58.
- Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults, (New Haven and London: Yale University Press, 2005): 200–245.
- Mary Kearl, “No More ADHD? New Changes to the Guidelines for Diagnosing Children and Adults,” ADDitude: Living Well With Attention Deficit, February 15, 2010.