ADHD, or Attention Deficit Hyperactivity Disorder, is characterized mostly by one of two major symptoms: inattention or impulsivity/hyperactivity. Despite the name of the disorder, individuals with the inattentive type seldom have any hyperactivity. There is also a Combined type, comprised of both inattention and impulsivity/hyperactivity.
In these children or adolescents with ADHD, the inattention or impulsivity is more frequent and severe than that found in their peers. Symptoms that interfere with functioning usually start to appear by age 7, although many individuals are diagnosed after signs have been present for a number of years. Some children are not diagnosed until teenage years, when demands of education increase. In order to be diagnosed with ADHD, some symptoms should be present in two settings, such as at home and at school (or work). Symptoms should interfere with social or academic functioning. Symptoms should not be caused by another disorder.
Signs and Symptoms:
Six (or more) of the following, for at least 6 months, which interfere with functioning or are inconsistent with developmental stage:
These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder. They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain. Diagnoses for mental health remain dominated by the medical model in this country. A diagnosis is necessary for insurance coverage for services, and for determining a proper treatment plan.
Children and adolescents with inattentive ADHD show signs consistently. At school, children may demonstrate careless mistakes, not pay attention to details, or appear to not be listening. Their work is often messy, and completed quickly without effort at details or as quickly as possible. Little thought is usually given to work, which is felt to be boring or unnecessary in the child's view. Children or adolescents with inattentive ADHD usually have difficulty staying on task, and persisting with a task until completion. They appear easily distracted, or as if they are daydreaming. They may shift erratically between tasks without finishing, and lose track of what they have done or what they have remaining to do.
Parents are particularly frustrated when these ADHD children fail to follow through with tasks or instructions. They often act on the first step requested, but usually forget the second and third. This can be with chores or schoolwork. Parents and teachers (even the child themself) can wrongly conclude that they are lazy or unmotivated, or outright unwilling to follow directions. This is not the same as when a child does not understand the directions. Children and adolescents with inattentive ADHD often have great difficulty organizing tasks and activities. Parents and teachers usually assume that a child is aware of how to complete a homework paper or to clean up their rooms and put away clothes, but these tasks often overwhelm a child or teen with this disorder.
Doing things that require persistence of effort over time are typically avoided. Kids with this disorder find such tasks to be unpleasant and are often strongly aversive to even approaching such a chore. This is particularly problematic since homework and paperwork are filled with the need for sustained effort and continuing organization. This avoidance is due to the child or adolescent's struggle with attention, and not simply due to an avoidant or oppositional attitude in general or in a specific situation. Work habits are usually inefficient, and the individual usually does not have the required materials for completing the work present. Papers and necessary instructions or tools are often scattered about, lost, or carelessly handled and damaged.
Individuals with this form of ADHD are easily distracted by off track stimuli, and often interrupt work to pay attention to noises or events that are easily ignored by others. They often forget appointments, or to bring important items requried for classes or activities. In conversations, they have difficulty staying on track, listening to others, or following details or rules.
Signs and Symptoms:
Six (or more) of the following, for at least 6 months, which interfere with functioning or are inconsistent with developmental stage:
These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder. They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain.
Impulsive ADHD is characterized by impatience, difficulty waiting, or blurting out inappropriately before questions are finished or when it's not their turn. They frequently interrupt others, or intrude on others to the point of causing social difficulties with peers or adults. Others may feel that they cannot get a chance to speak at all when someone with this disorder is talking. These children often fail to take the time to listen to or read directions. They may start conversations at inappropriate times, or interrupt others without notice. They may grab things from others, or touch things they are not supposed to, and often clown around as the center of attention. They often have accidents, knocking things over, running into others, or climbing and falling. Kids with impulsive ADHD can engage in dangerous activities, without awareness of risk.
Hyperactivity can occur with either the inattentive or the impulsive type of this disorder. It is commonly characterized as the inability to sit still or being fidgety. Often, excessive running or climbing occurs when it is inappropriate to do so. Children with hyperactivity can have difficulty with relaxation and leisure activities, as it is difficult for them to stop or slow down. Hyperactivity is hard to identify in toddlers, and there is normally a great deal of activity and constantly being into things and needing supervision. However, even with very young children, they can be noted to rush out without appropriate clothing, climb on furniture, or have trouble with group activities. School aged children can be observed getting up frequently in classes, playing with objects, tapping on things, or shaking their feet or legs excessively. Older children may leave the table when eating, wander off during homework or even watching TV, and be very noisy during quiet activities. Teenagers usually report feelings of restlessness, and frequent feeligns of bordeom.
Observations of problematic behavior are not usually consistent across all situations, but are often noted in many contexts. Issues will be apparent at home, school, social situations, and extra-curricular activities. Symptoms will be worse when sustained attention and effort are required. Tasks that lack novelty or appeal will quickly show difficulty. Unfortunately, these are the types of tasks that occur increasingly with age and school grade. Symptoms can be totally absent if the individual is strictly controlled, or in a situation that the person enjoys or if it is new. Frequent rewards for on task behavior can dramatically reduce symptoms. Symptoms are more likely to occur in group situations. Of note: often children and adolescents with ADHD exhibit some situations where they are capable of hyper focus. These are usually situations that the individual enjoys, when they can be hard to interrupt or distract, and they can continue for excessive periods of time. Playing video games is a frequent example where this type of focus is seen.
If you think that your child or adolescent might have an Attention Deficit Hyperactivity Disorder (ADHD) or any other mental health issue, you should talk to a professional about what to do and how to get help. Talking to your child's pediatrician is often a good way to get a referral to a competent psychologist, social worker or child psychiatrist. Another great source for referrals is your health insurance company. Many have on-line lists of professionals in their network of providers, or have a phone number on your insurance card to consult for referral sources. If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family. See the Cranberry Counseling page of this web site for more information, or use the Contact Us form.
Psychotherapy can help to reduce problems related to ADHD. Please go to the More on ADHD in Children and Adolescents page if you would like additional information on this disorder.