ADHD: symptoms and management

ADHD symptoms and types 

ADHD symptoms

ADHD is assessed based on three main areas of behaviour: difficulty focusing (inattention), hyperactivity and impulsivity. These behaviours determine the type of ADHD that is diagnosed. 

Inattention or difficulty focusing can make it hard for individuals with ADHD to pay attention to what someone is saying. It can make it difficult for them to get started with work, to complete work by a given deadline and to stay organised. They may also often be forgetful and consequently lose things. 

Hyperactivity and impulsivity can present in many different ways, such as: 

• Being unable to sit still for a long period of time
•  Fidgeting a lot (eg toe tapping)
•  Frequently interrupting others when they speak
•  Finding it difficult to control your behaviour when others are speaking
•  Not having the patience to wait for things (eg to wait in a queue) 

Together, these challenges around focus and impulsivity underlie why individuals with ADHD that is not appropriately managed and who drive are more likely to have a car accident and commit speeding offences. 

ADHD can also make it more difficult for individuals to manage strong emotions, that is, difficulty in self-regulation. This can present as persistent irritability, feeling impatient and more frequent outbursts of anger. 

Types of ADHD

Based on the behaviours described above, ADHD can be grouped into three types: 

• Predominantly inattentive type ADHD
•  Predominantly hyperactive–impulsive type ADHD 
•  Combined type ADHD

Inattentive type ADHD is particularly underdiagnosed as it can be easier to recognise hyperactive behaviours that are usually more disruptive — and so more noticeable — to others. It is present more commonly in girls.

Those who are hyperactive and impulsive as a child, when they get older, may see improvements in their hyperactivity and impulsivity but be inattentive.

Who is at risk of ADHD?

ADHD is an inherited condition. This means it strongly runs in families. 

If one parent has ADHD, there is a high chance that one or more of their children will also have ADHD. 

Getting a diagnosis of ADHD

Early diagnosis of ADHD in children is essential for improving their quality of life and outcomes in school. It also decreases the risk of developing mental health problems, such as substance abuse, anxiety disorder or depression in adulthood. Well-managed ADHD decreases the risk of accidents and trauma.

ADHD is more easily diagnosed in school-aged children as compared to adolescents and adults as it is easier to gather input from both the parents and school teachers regarding a child’s behaviour in multiple settings (ie at home and in school). 

For the diagnosis of ADHD, difficulties should be pervasive and present in multiple settings, and should interfere with or reduce the quality of social, academic or occupational functioning. 

In addition, several inattentive or hyperactive–impulsive symptoms should be present prior to the age of 12 years. All this evidence is easy to gather in school-aged children.

In adolescence, it can become more challenging to gather information from multiple settings as young persons in senior school, college or university are not overseen by one main teacher. This can make it more difficult to identify patterns of behaviour at school. Also, teenagers are more likely to try to mask their struggles so they can fit in. 

In adulthood, identifying characteristics of ADHD in multiple settings can become even more difficult because, when outside of the home, this relies on corroborating assessments from different coworkers. It can also be challenging to gather evidence that symptoms were present before the age of 12 years.

While there is a computer-based test to check for levels of inattention, hyperactivity and impulsivity in children and adults (Qb test), this may not accurately represent an individual’s difficulties in the real world. Consequently, when diagnosing ADHD in both adults and children, the Qb test is used alongside other evidence of ADHD as a useful additional tool.

Managing and treating ADHD 

ADHD can be managed with or without medicine.  Environmental adjustments,  behavioural support strategies and a healthy lifestyle are key elements to mitigate difficulties. Even for those on medicine, medicine alone without these other elements will not result in the expected improvement.

Environmental adjustments include a distraction-free workplace, small group teachings for children, breaking down large tasks into smaller steps, use of whiteboards, a planner and a visual timer, and structure and routine at home, in educational settings and in the workplace. 

Behavioural support includes coaching individuals with ADHD to develop executive functioning skills and skills for self-regulating emotion.

A healthy lifestyle includes maintaining a healthy bedtime routine, exercising regularly and following a healthy, balanced diet. 

ADHD medicine can be very effective and can help mitigate symptoms and improve quality of life if taken in conjunction with abovementioned strategies.

Loved ones can support an individual with ADHD by trying to remain calm and see things from their perspective, actively listening to them and focusing on encouragement rather than criticism.

It is also helpful to encourage a friend or family member with ADHD to address any other mental health or neurodevelopmental conditions that they may have alongside their ADHD, such as depression or autism. 

Autism and ADHD commonly co-occur. Up to two-thirds of children diagnosed with autism have ADHD, while around one in five children diagnosed with ADHD have autism. 

With appropriate management, outcomes for individuals with ADHD are very encouraging with the vast majority of individuals with well-managed ADHD having highly successful careers and developing rewarding relationships. The key is timely identification, diagnosis and appropriate management.