Talk about subjective: A diagnosis of ADHD isn’t based on any one simple test (wouldn’t that be nice?), but instead, a series of perceptions of someone’s behavior. So how can you be sure an ADHD diagnosis is really accurate? The truth is, it takes time and thoroughness by experienced health practitioners to identify this common condition. The first step is recognizing the signs and symptoms, so that you or your child can get an in-depth evaluation by a qualified pro that will put you on the right path to living better, happier, and healthier with ADHD.
First, What Exactly Is ADHD Again?
Simply put, ADHD, or attention-deficit hyperactivity disorder, is one of the most prevalent childhood conditions that can continue through adolescence and into adulthood. According to a recent report from the Centers for Disease Control and Prevention (CDC), 6.1 million children have been diagnosed with ADHD. Boys are more likely to be diagnosed (12.9%) than girls (5.6%). And it’s incredibly common among adults: Roughly 11 million have ADHD, or 5% of the adult population.
There are three main behaviors associated with ADHD, according to the National Institute of Mental Health (NIMH):
Of course, everyone is inattentive or impulsive at times. Who among us hasn’t forgotten an appointment at least once? Or felt like jumping out of their skin while having to stay in place during, say, a pandemic? But ADHD is different: It’s not being inattentive sometimes, or hyperactive now and then. In people with ADHD, these behaviors:
- are more severe
- happen more often
- interfere with quality of life
They can frustrate the person experiencing them and try the patience of friends, teachers, and bosses.
What Are the Signs and Symptoms of ADHD?
Inattention, hyperactivity, and impulsivity are the key behaviors, or symptoms, of ADHD, but someone doesn’t have to have all three to have the disorder. Someone with ADHD could have inattention, for example, while someone else with ADHD might have both inattention and hyperactivity-impulsivity. Most kids diagnosed with the condition have the combined type of ADHD. Let’s take a closer look at these behaviors:
People with symptoms of inattention may often:
- Miss details, making careless mistakes in schoolwork, at work, or during other activities.
- Have problems sustaining attention. Their focus wanders during conversations, lectures, or reading.
- Be accused (somewhat fairly) of “not listening.”
- Not follow through, whether it’s finishing up schoolwork, completing chores, or completing tasks at work. They may start with good intentions and gusto, but quickly lose focus and get easily sidetracked.
- Have problems organizing what to do and in what order. They may have trouble keeping their room, desk, or office tidy, have messy work, poor time management, and fail to meet deadlines.
- Avoid, or at least dislike, tasks that require sustained mental effort. (Hello, homework!) In teens and older adults, it can mean (not) preparing reports, completing forms, or reviewing anything lengthy.
- Lose things, including but not limited to school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and (ka-ching) cell phones.
- Be easily distracted by unrelated thoughts or stimuli.
- Be forgetful, not just once in a while but in daily life: not returning texts or emails, missing appointments, forgetting to RSVP.
People with symptoms of hyperactivity may often:
- Move around a lot in their seats.
- Pop out of their seats in situations when it’s clear staying seated is the M.O., like in the classroom or the office.
- Run around or start climbing furniture, counters, etc. (for kids) or, in teens and adults, often feel restless.
- Be unable to play or do hobbies quietly.
- Be constantly in motion or “on the go.”
- Talk excessively.
People with symptoms of impulsivity often:
- Make conversational gaffes: blurting out an answer before a teacher has finished a question, ending other people’s sentences, or speaking without waiting for an opening.
- Have trouble waiting for a turn.
- Interrupt or intrude on others, for example in conversations or activities.
- Engage in risky behaviors without thinking through the consequences.
- Have angry outbursts.
When Do Signs of ADHD Begin?
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. They are often mistaken for emotional or disciplinary problems, and they can also be completely looked over in kids who are quiet and well-behaved but are inattentive, leading to a delay in diagnosis. For adults with undiagnosed ADHD, they may have been suffering with a long history of mediocre or poor grades, problems in the workplace, or complicated or fizzled-out relationships.
ADHD symptoms can change as a person ages and might look different at different stages of life. In young kids with ADHD, hyperactivity-impulsivity is the most predominant symptom. In the elementary school years, inattention may become more of a problem and more obvious, and cause struggles with keeping up in class.
Some good news: By adolescence, hyperactivity seems to lessen, though it may show more often as feelings of restlessness or fidgeting, while inattention and impulsivity remain. Many adolescents with ADHD also struggle with relationships and being antisocial. Inattention, restlessness, and impulsivity are behaviors that continue into adulthood, but can be managed.
ADHD in Women vs. Men
Symptoms of ADHD can also look different among the genders. While ADHD symptoms can be more “outward” in men and boys, appearing as unruly, reckless or hyper behavior, in women and girls, symptoms are often more internalized.
Women and girls with ADHD may have awesome ideas but can’t seem to act on them or see them through. They may criticize themselves for the mess in their rooms or homes and feel embarrassed to have people over. They feel guilty about the birthday cards and thank you notes never sent, and friends “joke” that they’re flakey or spacey. It’s draining just trying to stay organized, and one more thing at the end of the day can put them over the top emotionally. They might feel impostor syndrome deeply, like any minute someone’s going to discover behind their smiles that they are barely hanging on.
Just about everyone has had this nagging feeling of insecurity sneak up on them at some point. But ADHD, with all the executive functioning challenges it brings to any situation, exacerbates that feeling. It can leave you unfairly beating yourself up and clouding a fair picture of yourself or your kid as a whole person, one with many attractive qualities, impressive accomplishments, and a fan club of people in your lives who think you guys are pretty cool.
So, What Do I Do If My Child or I Have Signs of ADHD?
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in the disorder. A few boxes need to be checked for a person to receive a diagnosis of ADHD: The symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting (six months or more), interfere with the person’s functioning, and cause him or her to fall behind developmentally for his or her age.
A good doctor will also ensure that any symptoms aren’t due to another medical or psychiatric condition. Most kids with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, symptoms need to have been present before age 12. ADHD doesn’t develop suddenly during adulthood, according to research. Most likely, it was never diagnosed during childhood.
How Is ADHD Treated?
The first step is an accurate diagnosis, which doesn’t happen in one office visit or a Zoom call. (If it does, get another opinion.) A qualified mental health care professional or physician should gather information from multiple sources, including the ADHD symptom checklist, standardized behavior rating scales, a detailed history of current and past functioning, and with consent from parents, interviews with family members, teachers, or others who know the person well.
If you or your child is diagnosed, probably the very next thing you’ll be wondering is how to manage ADHD. Treatment can include a number of options, including behavior therapy, which teaches kids strategies to succeed at school, at home, and in relationships, and is recommended by the American Academy of Pediatrics for children under six.
Behavior therapy should include behavioral interventions during class time. For example, those may include work breaks, clean-out dates to de-clutter a workspace or book bag, and if possible, soft classical music to block out distractions. Adults, too, can greatly improve their executive functioning skills with cognitive-behavioral therapy (CBT) programs developed specifically for living with ADHD.
For kids 12 and under, several sessions of parent behavior therapy (also known as parent training in behavior management or just parent training) using positive methods can be more effective than behavior training in kids alone. Parents, after all, have the greatest impact on their kids’ improvements. Your child will also have a school treatment plan, which might include an Individualized Education Plan or 504 plan that describes accommodations, like extra time on tests and getting enough breaks to move around.
Your healthcare provider may also recommend medication to treat ADHD symptoms. Stimulants may sound like a counterintuitive treatment for ADHD, but they boost the brain chemicals dopamine and norepinephrine, which help with staying focused. While the doses prescribed for ADHD don’t make these meds habit forming or at risk for abuse, still, with any stimulant, there’s the possibility of overuse and addiction. Air any concerns and raise questions with your doc.
If stimulants aren’t helping or causing unpleasant side effects, a doctor may prescribe non-stimulants. Non-stimulants don’t work as quickly, but they also help improve focus, attention, and impulsivity. Antidepressants aren’t approved by the Food and Drug Administration for the treatment of ADHD, but they may also be used alone or in combination with stimulants to treat ADHD to improve both attention and impulsivity.
Living with ADHD can be challenging and frustrating, for sure, for the person with it and for the people who care about them. But advances in drug and talk therapy, increased awareness of ADHD, and behavior modifications can help manage symptoms, so kids can get on with enjoying childhood and adults can be successful at work and in their personal lives. There may be some trial and error with what works, but like many conditions, ADHD is one that can be managed. You’ve got this!