ADHD is a combination of hyperactivity, attention problems and impulsivity 2. Therefore the signs and symptom of ADHD are those one would expect to see with a child having problems in these areas.

Everyone Is On The Continuum

It is extremely important to realize that all of the ADHD traits fall along a continuum. Every person has some degree of ability to focus. For some of us it is harder compared to others, but that does not mean that we automatically have ADHD. It is only when the difficulty has an “impact” on our daily lives that we consider it indicative of ADHD. The same is true of impulsiveness. Some of us are very careful and some are impulsive. We would probably not want an entire world of very careful people. The following chart illustrates the three continuums related to the diagnosis of ADHD:

"Normal" Risk ADHD

Activity Level: Quiet ___________ Active

Attention: Focused ___________ Distractible

Impulsivity: Careful ____________ Impulsive

Note especially that the areas to the right may represent a set of patients who are “at risk” for ADHD. These people may be functioning reasonably well until some family or psychological stressor, poor diet, inappropriate school placement or other factor pushes them over the edge to ADHD.

In terms of hyperactivity, these children are often described as constantly moving, acting as if they are “driven by a motor” and unable to sit still. Currently, this represents a small portion of the children I evaluate for ADHD. As children get older this often evolves into more of a general fidgetiness rather than true hyperactivity.

Focus and Attention Problems

Focus and attention issues are much more commonly what brings children in to be evaluated. ADHD children are often unable to pay attention in school, sometimes to the point of being unable to learn. These children will be falling behind in reading, math or other subjects. They are highly distractible, often daydreaming or losing focus when there is the slightest outside distraction. They very often have difficulty organizing themselves, losing or forgetting to turn in homework, failing to write down assignments, and being unable to keep track of their possessions. At home they may have difficulty doing the routine things necessary to get ready for school in the morning, distractedly wandering around when they should be brushing their teeth, getting dressed, etc.

What is often confusing and frustrating for parents is that in all but the most severe cases, this difficulty focusing is not present in all areas. Some ADHD children may focus very well on building with Legos, art, sports or even reading things they like. It is when they are called upon to exert mental energy doing things that are challenging that the focus issue becomes most prominent. (Most children with ADHD can focus on watching television or video games, so this is no help at all in arriving at a diagnosis).

ADHD and Learning Disabilities

It is also important to realize that many children with ADHD — 30 to 40 percent, in fact — also have learning disabilities, one example of which is dyslexia, a type of reading disability. The child with a reading disability may appear to have difficulty focusing on written material because it is just so difficult for them, not because of ADHD. Any child with ADHD who is falling behind academically should be evaluated for learning disabilities.

Impulsivity

Finally, impulsivity manifests as difficulty containing the urge to act without thinking. This may show as difficulty waiting one’s turn, blurting out answers in school and difficulty in navigating interactions with other children. Impulsivity can often cause patients with ADHD to have significant problems in social relationships.

Inattentive Subtype

For the child with inattentive subtype ADHD, there is a very different picture. These children are usually quiet, well-behaved and socially appropriate. However, they are unable to focus enough to complete simple tasks at home or, most importantly, to succeed academically. They may be diagnosed later because they do not cause any trouble, and it is only after they really fall behind that the problem is addressed. While boys are more than twice as likely to be diagnosed with ADHD as girls, girls may be more likely to be diagnosed with inattentive subtype ADHD.

Persistence into Adulthood

A final word about the symptoms of ADHD in adults: Although many children “grow” out of ADHD, or at least do not meet criteria for ADHD as adults, there are many adults who do have ADHD. These adults are rarely visibly hyperactive, but they may be fidgety. More importantly, their lack of focus and organization, as well as impulsivity, can cause severe problems at home and at work. They have higher rates of divorce and unemployment resulting from these issues. Although likely overdiagnosed recently, true ADHD in adults can be a very significant and debilitating issue.