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What Does ADHD Really Look Like

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What Does ADHD Really Look Like

Everyone is familiar with the term ADHD. Unfortunately, the term is thrown around too frequently and inaccurately.  As a result, we are quick to label any child with behavior problems as having ADHD, which is not always true.  And in order for children to get the appropriate tools and services to help them, they need to be diagnosed properly.

Anyone can look at a list of symptoms of ADHD and identify with at least a handful of them.  Attached here is a complete description of the disorder from the DSM-5.

Overview of the DSM-5TM medical classification system for ADHD

  • A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:1
    • For children, six or more of the symptoms (Table) have persisted for at least 6 months to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic/occupational activities. Please note: the symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility or failure to understand tasks or instructions1
    • For older adolescents and adults (age 17 and older), five or more symptoms are required (Table)1
  • Several inattentive or hyperactive-impulsive symptoms present prior to age 12 years1
  • Several inattentive or hyperactive-impulsive symptoms present in two or more settings (e.g. at home, school or work; with friends or relatives; in other activities)1
  • Clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning1
  • Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder, and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal).1

DSM-5TM diagnostic criteria for ADHD: symptoms of inattention, hyperactivity and impulsivity. 

Symptoms of inattention Symptoms of hyperactivity and impulsivity
Often fails to give close attention to detail or makes mistakes Often fidgets with or taps hands and feet, or squirms in seat
Often has difficulty sustaining attention in tasks or activities Often leaves seat in situations when remaining seated is expected
Often does not seem to listen when spoken to directly Often runs and climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless)
Often does not follow through on instructions and fails to finish schoolwork or workplace duties Often unable to play or engage in leisure activities quietly
Often has difficulty organizing tasks and activities Is often ‘on the go’, acting as if ‘driven by a motor’
Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort Often talks excessively
Often loses things necessary for tasks or activities Often blurts out answers before a question has been completed
Is easily distracted by extraneous stimuli Often has difficulty waiting their turn
Is often forgetful in daily activities Often interrupts or intrudes on others

 

It is extremely important to remember that in order to properly receive the diagnosis of ADHD, one must show a persistent pattern of behavior that interferes with functioning or development.  In other words, just because your child is annoying and doesn’t always listen to you does not mean he has ADHD.

Sometimes, it is simply that the parenting skills need a bit of improvement in order to help your child behave more appropriately.  If the parenting skills are up to par, and you are still noticing problems both at home and getting reports that teachers are having similar problems at school, then it is more likely that there is actually an issue.

In order to be diagnosed with ADHD, the problems must be present in at least two different setting, such as home and school, or for adults, home and work.

Now that you’ve seen the list of symptoms and understand a little bit more about ADHD, I’m going to present two examples of what ADHD really looks like.  These examples are based on real children with the diagnosis of ADHD.

Inattentive Type

As a toddler, B was very active and easy going.  He reached all of his developmental milestones on time.  He loved to play and act silly and genuinely was happy just having fun.

Once he began kindergarten, problems started to emerge.  He became very forgetful, losing important items literally on a daily basis.  He would forget to take his lunch pail with him and would just leave it on the table where he ate and then run off to play, never going back for it.  He would lose his jacket every day, as he would just take it off and throw it wherever he was, not remembering to pick it up before he left.  He couldn’t remember to bring his backpack home, what his homework was, and so on.

While he is a bright child, he could not sustain attention during lessons, so by 2nd or 3rd grade, he was falling behind.  He began to act silly in class, so that nobody would notice that he didn’t know what page they were on or the answers to questions.  If another class was outside, or the school gardener was working, or an airplane flew over, or he could hear music, or noticed a fly bussing around, his attention would shift to that instead of the lesson.

When given tasks or instructions, he had difficulty following them.  If the teacher gave three instructions at once, he usually only remembered one or two.  At home, if he was asked to do something, he usually forgot what he was supposed to do by the time he walked up the stairs.

As he got older, he continued losing things, even though his possessions were more valuable.  From school books to clothing to calculators and electronic devices, nothing was safe.  He began avoiding difficult tasks, and only signed up for the easiest classes in high school.  These classes still proved difficult for him, as his total lack of organization made it nearly impossible to keep up.

He required a lot of support both at home and at school to stay on task.  He needed a lot of reminders and assistance with organization.  He made it through high school, but school was always very much harder for him than for most kids.  Sometimes, the frustration led to depression and took a toll on his self-esteem.

Hyperactive/impulsive Type

Since birth, R never slept much.  He seemed to always be on the move, as if he was driven by a motor.  His family often joked that there was no off switch.  He hit most developmental milestones quite early.  He was walking and talking by 10 months old.

He always knew exactly what he wanted, and was persistent in insisting on having things his way.  Even as a toddler, he chose his own shoes and clothing, throwing what he didn’t like in the garbage!

Once he began nursery school, he could not sit still, even for a short period of time.  He often blurted while teachers were speaking and interrupted other children’s play. It seemed that he could not delay gratification. It had to always be his turn.  He was very social and talked a mile a minute.  He needed constant stimulation, which was exhausting to his family.

As he got older, it was clear he was extremely bright, but constantly fidgeting.  Even as a teenager, he could not sit still and continued to interrupt and annoy others.  This made him socially awkward and, as a result, it was difficult for him to keep friends.

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In both of these cases, you can see that the symptoms were persistent and demonstrated both at home and at school.  These were not just defiant kids, but kids who were really struggling to manage what was expected of them and what was developmentally appropriate.  The good news is that once each of these kids were properly diagnosed and treated, they made great progress.  With a combination of talk-therapy, social skills training and medication, these kids were able to function at a high level.  With treatment, they improved in school, behaved better at home, and thrived socially.

If you suspect your child might have ADHD, it is best to get him assessed as soon as possible.  Like most things, early intervention and treatment is key to your child’s success and will allow for the best possible outcome.

Lori Freson Lori Freson is a Licensed Marriage and Family Therapist in Southern California. She has been working in the mental health field since 1997, and has been a licensed therapist since 2002. Lori currently works in her own thriving private practice in Encino and Sherman Oaks, where she serves the San Fernando Valley and Los Angeles areas.
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