The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for ADHD, as defined by the American Psychiatric Association, are the most widely used criteria and describe three subtypes of ADHD based on the predominant symptom pattern. The core symptoms of ADHD are: inattention, impulsivity, and hyperactivity that improve or change with time, as the person grows up.
ADHD in Children
According to the predominating symptoms in school aged children, three subtypes of ADHD are distinguished:
ADHD – Inattentive Type
- Can not concentrate
- Easily distracted by irrelevant stimuli.
- Does not seem to listen to someone speaking.
- Does not pay attention to details
- Makes mistakes, because of inattention
- Finds it difficult to follow instructions
- Avoids procedures that require systematic mental effort
- Forgets to do school homework.
- Loses things, including personal items.
- Is generally disorganized
This type of ADHD is common in school aged children who might not have been diagnosed, as they were not ever disruptive. In some cases, they are kids who were diagnosed at an older age, when they had overcome the hyperactive behavior displayed at a younger age. In other cases, it might be an entirely different psychiatric state, than the other subtypes of ADHD. The child, who is extremely inattentive while doing schoolwork, may be fully focused when playing video games, watching TV, carrying out practical procedures or when being tested by a psychiatrist.
ADHD – Impulsive / hyperactive Type
- Difficult to stay still
- Moves arms, legs or squirms on his/her seat
- Continuously looks around and disturbs other
- Stands up, when it is forbidden
- Runs and climbs excessively
- Reacts without thinking
- Responds before any sentence is completed
- Talks excessively
- Finds it difficult to wait for his/her term
- Does not follow the rules in activities with peers
- Interrupts or disturbs the others
- Tends to be accident prone
- Does not learn from the consequences of his/her behaviour
- Parents and teachers find difficult to understand why they act so inappropriately
This type of ADHD is more frequent in children of younger age that present with an extreme hyperactive and impulsive behaviour. In some cases, their problem of attention deficit may not be entirely obvious, probably, because they have not as yet been called to function in a demanding school environment. In secondary school, some children retain their extra level of physical activity, while others may be able to stay seated in a classroom, showing that their hyperactivity has lessened, but still they may be talkative, noisy, causing problems to the teacher and their peers by fiddling, scribing and touching everything.
ADHD – Combined Type:
It is also a common type of ADHD in children and adolescents that present with some of the above symptoms: inattention, hyperactivity and impulsivity that may eventually lead to impairment of the quality of their life, if not early diagnosed and properly managed.
In general, the clinical picture of ADHD varies from child to child. Usually, there are variations in the intensity of symptoms among children, whereas fluctuations can be observed even in the same child, during the day and from hour to hour. Nevertheless, for documenting an ADHD diagnosis, the above described symptoms should be expressed both at home and at school, and should cause significant impairment in academic achievements and social interactions.
It can be challenging or even overwhelming to raise kids with ADHD. It will help if you remember they aren’t “bad,” “acting out,” or ‘difficult’ on purpose. This is their defect; they have difficulty in controlling their behaviour without behavioral therapy or/and medication. In any case, they certainly need understanding and support.
ADHD in Adults
ADHD in adults is defined as a clinical syndrome characterised by the presence of developmentally inappropriate levels of inattention, hyperactivity and impulsivity, starting in childhood and leading to impairment of their functioning as adults. Epidemiological studies estimate the prevalence of ADHD in adults at the range of 2-4%. Since the recognition of ADHD is relatively recent throughout Europe, many adults with the disorder have not been diagnosed or treated for ADHD as children. Besides, many professionals working in adult mental health services remain unaware that ADHD frequently persists into adult life, since they ignore the clinical presentation and the consequences of ADHD across lifespan. Another reason for underdiagnosis and treatment of ADHD in adults is the age-dependent changes in the presentation of ADHD symptoms. Research has shown that symptoms of ADHD persist in adult life in almost 60% of cases; therefore recent guidelines recommend that ADHD should be recognized and appropriately treated throughout the lifespan.
More common symptoms of adult ADHD are the following:
Symptoms of inattention
- Easily distracted
- Poor listener
- Difficulty in completing tasks
- Avoids tasks requiring sustained mental effort
- Champion in procrastination
- Forgetful in daily activities
- Loses things very often
Symptoms of Hyperactivity
- Restless, “On the go”
- Cannot relax
- Excessive talking
Symptoms of impulsivity
- Interrupts others when they talk
- Impulsive behavior,
- Talks without thinking
- Answer before the sentence is completed
- Hot Temper, mood swings, outburst of anger
- Car accidents
Moreover, some unrecognised sufferers may be prone to gambling, smoking, addiction to alcohol and substance abuse.
Across lifespan, the inattentive symptoms and impulsivity are more consistent, whereas, hyperactivity may become internalized or manifest itself differently in older adolescents and adults, e.g. as inner restlessness, inability to relax or chattering incessantly. Hyperactivity may also be expressed as excessive fidgeting, inability to sit still for long, when sitting is expected (at the table, in the movie, in church or at symposia), or “being on the go” all the time. Impulsivity may be expressed as impatience, acting out without thinking, spending impulsively money, starting new jobs and relationships on impulse, and sensation seeking behaviour.
Adults with ADHD are more prone to quit their job or they often get fired. They change jobs until they find a job that suits them. They prefer tasks with motion and action that stimulate and put them at risk. Inattention often presents as distractibility, disorganization, being late, being bored, need for variation, risky driving, trouble in prioritizing, starting and finishing tasks, difficulty in making decisions, lack of overview, and sensitivity to stress. Moreover the clinical expression of ADHD is complicated by comorbids (other psychiatric disorders) that often coexist with the disorder. If the above difficulties are not treated appropriately, they may cause associated behaviours, emotional, social, vocational, marital, and academic problems.
Adults are usually underachievers in their academic carrier, personal or social life or at workplace. Their relationships are problematic because they experience lifetime mood liability with frequent highs and lows, and short-fuse temper outburst, anxiety, and depression. In their personal life, they often experience problems in their marriage, unstable relations, divorces etc. Low self-esteem may lead in poor physical health, and various types of addiction e.g. addiction in TV, Computer, gabbling, smoking, alcohol and substance abuse. You may read more about adult ADHD in the “European consensus statement on diagnosis and treatment of adult ADHD”: The European Network Adult ADHD