What is ADHD? Common—and Surprising—Symptoms

Attention deficit hyperactivity disorder (ADHD), once thought to be the fault of lousy parents or a conspiracy propagated by drug companies, is a brain-based disorder, and quite the disorderly disorder it can be.

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The part of the brain affected is called the prefrontal cortex, which lies directly behind the forehead.  It is responsible for “executive functioning,” which includes attention, planning, problem solving, decision-making, and reasoning.  Trouble with executive functioning translates into two groups of symptoms:

Group #1: Inattention.  Symptoms like disorganization, messiness, forgetfulness, and losing things drive parents of inattentive kids and partners of inattentive adults up the wall.  Other signs include not paying attention to details, distractibility, spacing out, daydreaming, not following through, and trouble focusing on tedious tasks.  Also difficult for an individual with inattention is prioritizing what’s happening around them. For example, for a kid with ADHD, the TV in the background and the garbage truck outside seem just as important as the homework in front of them. Individuals with these symptoms are said to have ADHD Predominately Inattentive Type, which is the most common type among girls.

Group #2: Hyperactivity and impulsivity.  Picture the arms-and-legs tornado of the Looney Toons Tasmanian Devil, leaving a trail of destruction in his wake.  Hyperactive kids seem to have a motor—they are often in constant motion, touch everything, and have a hard time waiting their turn.  They also have a motormouth—talking a blue streak, blurting out answers, and interrupting.  Hyperactive adults often feel restless, have a hard time sitting at a desk or in a meeting, and may find themselves making impulsive purchases, repeatedly starting and abandoning projects, being chronically late, or having trouble controlling anger.  Individuals with these symptoms have ADHD of the Predominately Hyperactive-Impulsive Type.

Then there are the kids and adults who have both sets of symptoms. This is called ADHD Combined Type and is the most common variation.

See also: What Is ADD?

An interesting symptom that doesn’t get much…um…attention is hyperfocus.  Despite its name, ADHD may not be a “deficit” of attention at all, but rather an inability to regulate attention.  On a spectrum of attention, let’s call one end The Disco Ball, where attention is scattered and boring tasks are quickly abandoned.  We’ll call the other end The Laser Beam.  When a task is interesting or stimulating, focus becomes intense, sustained, and shifting to another task is difficult.  You can think of hyperfocus as Attention Surplus Disorder, as it were.  Folks with ADHD move from The Disco Ball to The Laser Beam without much in between.

How Common Is ADHD?

ADHD affects up to 7% of kids, which translates to at least one or two kids in every classroom.  It also affects around 4% of adults.  Why the lower percentage of adults?  Some kids with a specific genetic variation of ADHD will grow out of it, but the majority won’t.  Overall, about 60% of kids with ADHD grow up to be adults with ADHD.

Why Is ADHD Often Misdiagnosed?

ADHD often goes unrecognized but is also frequently overdiagnosed.  Overdiagnosis can occur because most people, especially kids, are inattentive, hyperactive, or impulsive sometimes, or they may have a sleep disorder that causes similar symptoms.  But it’s important to remember that for kids and adults with true ADHD, the symptoms are persistent across many aspects of life and have negative academic, work, or social consequences.

The most important thing to remember is that ADHD is not equivalent to stupidity or laziness. 

As for under-diagnosis, women and girls with ADHD often fall through the cracks because they may show more subtle signs of the disorder like messiness, forgetfulness, or motivation difficulties, or they simply don’t cause enough trouble to trigger a second look.  Also, gifted students who are able to compensate for their difficulties often go under the radar, but without treatment they are missing out on achieving their full potential. 

Also, up to 45% of kids and 81% of adults with ADHD have another overlapping disorder like a learning disability, depression, or anxiety.  This can complicate getting an accurate diagnosis.  In addition, medications for one problem may interfere with ADHD medications or vice versa.  For example, Ritalin can make OCD, an anxiety disorder, worse.

What Are the Treatments of ADHD?

Adults who have grown up with ADHD, but without a diagnosis, have often been labeled as stupid or lazy, and their self-esteem and relationships may have suffered as a result.  The most important thing to remember is that ADHD is not equivalent to stupidity or laziness.  For both adults and kids, an important step is finding a good therapist or other supporter who knows about the disorder and can help with issues of worth or competence.

A common and effective treatment is stimulant medication, such as Ritalin or Concerta, or non-stimulants like Strattera.  Talk to your doctor about medications for more information, benefits, and side effects.

Behavioral strategies abound as well.  A neuropsychologist can assess an individual’s strengths and weaknesses and give recommendations for action.  A good cognitive-behavioral therapist can work on building skills and strategies.  In the meantime, here are some medication-free tips for ADHD, for both kids and adults….

Medication-Free ADHD Treatments for All Ages

• Get more sleep. Kids (and some adults) with and without ADHD often manifest fatigue not by getting tired, but by getting wired.  A 2012 study in the journal Pediatrics shows that behavior deteriorates when sleep time is cut by as little as 30 minutes, and improves with an extra half hour or more. So make sure that you or your child gets plenty of zzz’s.
• Exercise.  A recent study showed that just 20 minutes of exercise improved kids’ self-control and attention, whether or not they had ADHD.  Kids with ADHD showed specific behavioral improvements as well. Here’s a great episode from Get-Fit Guy about how to get your kids fit.
• Take one thing at a time.  Multitasking quickly descends into chaos for those with ADHD.  Focus on doing one activity at a time. Also, multi-step directions can be difficult to process for kids with ADHD.  A request like “Clear your dinner plate, find your backpack, and start your homework” will likely result in several detours and much exasperation.  Break it down into three separate requests, however, and everyone will be happier.

Medication-Free ADHD Treatments for Kids 

• Praise good behavior.  Often, kids with ADHD get negative feedback about their attention, motivation, or behavior.  A positive, loving, non-critical, and helpful home is the best foundation.  When a kid with ADHD is behaving appropriately, praise him and his efforts.
• Build in immediate reinforcement.  A recent book for psychologists described this tactic for a boy with ADHD: The teacher wrote answers to worksheet questions in invisible marker; he could answer the question and immediately color the space to reveal whether or not he was right.  He went from pestering the kids next to him to answering almost every question correctly.  Immediate feedback pays off.  Try offering praise or another reward immediately after good behavior.
• Be on the lookout for learning disabilities. Dyslexia or difficulties solving math problems commonly coexist with ADHD. 
• Make eye contact and gentle physical contact when you need their attention.  Calling from the adjacent room, “Put on your shoes!  We’re late!” is like talking to the wind.  Instead, go to the child, touch her arm, look her in the eye (requesting “Look at my eyes,” can help), and then ask her to put on her shoes.
• Request a desk in the front of the class.  Not having to filter out a classroom’s worth of distraction can work wonders.
• Include more “green time.”  In a 2009 study, just 20 minutes of walking in a park, compared to 20 minutes of walking in an urban downtown area or a residential area, was enough to improve attention in kids with ADHD.

Medication-Free ADHD Treatments for Adults

• Choose an organizing system and stick to it.  Many adults with ADHD know they need to get organized, but they abandon system after system.  Pick one and stick to it for at least a few weeks, not just a few days. Get-It-Done Guy has an article to help you create a custom organizational system.
• Break down onerous tasks into small chunks.  Tedious tasks, like filing or sorting, often fall by the wayside.  Tell yourself you’ll file 5 pieces of paper, sort 10 items, or pay 2 bills.  Once the task is started, often the momentum will carry you beyond the initial quota. Check out the article on speed-dating your tasks to help you stay on track.
• Use technology to keep you focused.  One patient of mine created a text alarm on his laptop; it scrolled across the screen every 15 minutes and read “Are you doing what you’re supposed to be doing?”  Another patient set her phone alarm to beep at 20-minute intervals in the early afternoon, when she knew her medication was likely to be wearing off. How can you use technology to keep you motivated and on track?

Finally, be patient.  It isn’t possible to will oneself out of ADHD, but with support and persistence, it can be well-managed. Just look at Modern Manners Guy, Richie Frieman.  He struggled with ADHD his entire childhood, and now he’s published a bestselling book!

Thanks for reading and for your, well…attention!

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Weiss MD, Worling DE, Wasdell MB. (2003).  A chart review study of the inattentive and combined types of ADHD.  Journal of Attention Disorders, 7(1):1-9.

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O et al.  (2006).  The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.  American Journal of Psychiatry, 163(4): 716-23.

McGough JJ, Barkley RA.  (2004).  Diagnostic controversies in adult attention deficit hyperactivity disorder.  American Journal of Psychiatry, 161: 1948-1956.

Shaw P, Gornick M, Lerch J, Addington A, Seal J, Greenstein D, Sharp W, et al. (2007).  Polymorphisms of the dopamine D4 receptor, clinical outcome, and cortical structure in attention deficit/hyperactivity disorder.  Archives of General Psychiatry, 64(8): 921-31.

Spencer TJ, Biederman J, Mick E.  (2007).  Attention deficit/hyperactivity disorder: diagnosis, lifespan, comorbidities, and neurobiology.  Journal of Pediatric Psychology, 32(6): 631-42.

McGough JJ, Yang M, McCracken JT, et al. Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatry. 2005;162:1621–7.

Gruber R, Cassoff J, Frenette S, Wiebe S, Carrier J.  Impact of sleep extension and restriction on children’s emotional lability and impulsivity.  Pediatrics.  2012; 130(5):e1155-61.

Pontifex MB, Saliba BJ, Raine LB, Piccheietti DL, Hillman CH.  Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder.  Journal of Pediatrics.  2013; 162(3): 543-51.

Neef NA, Perrin CJ, Madden GJ.  (2012).  Understanding and treating attention-deficit/hyperactivity disorder.  In APA Handbook of Behavior Analysis: Volume 2.  Washington, D.C.: American Psychological Association.

Taylor AF, Kuo FE. Children with attention deficits concentrate better after walk in the park.  Journal of Attention Disorders, Vol 12(5), Mar, 2009. pp. 402-409.

Disclaimer: All content is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your personal health provider. Please always seek a licensed physician in your area regarding all health related questions.  

ADHD child image courtesy of Shutterstock.