Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning and development.
ADHD is one of the most common neurodevelopmental disorders, affecting approximately 4% of children and adolescents and 2.5% of adults worldwide. While symptoms often begin in childhood, many individuals are not diagnosed until adulthood.
ADHD can significantly impact a person’s life, affecting their academic performance, work productivity, social relationships, and overall well-being.
Below are some of the common signs of ADHD according to the DSM-5, keeping in mind that this is not an exhaustive list.
It is important to note that while this article provides an overview of the signs and impact of ADHD, it should not be used as a substitute for professional diagnosis and guidance. If you suspect that you or someone you know may have ADHD, it is crucial to consult with a qualified healthcare provider for an accurate assessment and appropriate treatment options.
Inattention
ADHD is characterized by signs of either inattention, hyperactivity/impulsivity, or both.
Below are some of the ways in which inattention may present:
Lack of attention to detail
Examples:
- Making careless mistakes in work
- Misses or overlooks details
- May fail to notice mistakes in work
Difficulty focusing
Examples:
- Struggle to pay attention during class or work meetings
- Having to re-read sections of a book because of losing focus
- Finding uninteresting tasks especially hard to focus on but can hyperfocus on more enjoyable activities
Difficulty listening
Examples:
- May not appear to be listening
- May not respond to questions
- Mind-wandering during conversations
Difficulty completing tasks
Examples:
- Work projects, homework, and chores are hard to complete
- Struggle with following instructions
- May get easily distracted from the task at hand
Organization difficulties
Examples:
- Difficulty making a plan and sticking to it
- Mess or disorganized work or home space
- Poor time management
- Struggle to meet deadlines
Avoid tasks requiring sustained focus
Examples:
- Feels overwhelmed if a task is too long or complex
- Dislikes tasks with too many steps
- Dislike for completing forms or writing reports
Misplaces items
Examples:
- Often loses homework
- Often misplaces keys, phone, or wallet
Easily distracted
Examples:
- Switches attention between tasks suddenly
- Distracted by unrelated thoughts
- Phone notifications can distract from the task at hand
Forgetfulness
Examples:
- Forgetting appointments
- Excessive reliance on reminders
- Forgetting to complete chores
- Forgetting family member’s birthday
Hyperactivity and impulsivity
Below are some of the ways in which hyperactivity and impulsivity can present in ADHD:
- Fidgets, e.g., tapping hands or feet
- Difficulty remaining seated
- Feeling restless
- Struggle to remain quiet during activities
- Often ‘on the go,’ e.g., not wanting to stay in one setting for too long or having a hectic schedule
- Talks excessively
- Blurts out answers, e.g., answering before a question has been asked or finishing people’s sentences
- Trouble waiting their turn, e.g., in a queue or during conversations
- Often interrupts others, e.g., during conversations or taking over activities
Is masking a sign of ADHD?
Masking refers to the conscious or subconscious efforts of individuals with ADHD to hide or suppress their symptoms in order to conform to social expectations or avoid negative judgments and stigmatization.
Examples of masking behaviors include hiding true feelings, suppressing soothing behaviors like stimming, being overly apologetic, striving for perfectionism, and expending a lot of energy actively listening to ensure no social cues are missed.
Individuals with ADHD may learn to mask their symptoms, especially if they have not been diagnosed and treated.
This can make it even harder for clinicians to identify ADHD, as the individual may appear shy or socially anxious rather than displaying typical ADHD symptoms.
Masking is particularly common among girls and women with ADHD, as well as racial and ethnic minority groups, leading to underdiagnosis or misdiagnosis in these populations.
While masking can offer some benefits, such as helping individuals with ADHD feel like they fit in better socially, excessive reliance on masking can lead to problems like burnout, decreased self-esteem, increased anxiety, and a low sense of self.
ADHD in children
ADHD is most commonly diagnosed in childhood, with symptoms typically appearing before the age of 12.
Children with ADHD may exhibit a combination of inattention, hyperactivity, and impulsivity that can impact their academic performance, social interactions, and overall development.
They may struggle with following instructions, completing tasks, and regulating their behavior. ADHD in children can also lead to emotional difficulties, such as low self-esteem and frustration.
Early diagnosis and intervention are crucial for children with ADHD to receive appropriate support and accommodate their needs.
Treatment options for children may include medication, behavioral therapy, and educational interventions to help them manage symptoms, develop coping strategies, and thrive in their personal and academic lives.
ADHD in adults
Although ADHD may be seen as a childhood condition, it can persist into adulthood, presenting unique challenges.
Adults with ADHD may struggle with managing work, relationships, and emotions. They may face difficulties with time management, financial planning, and decision-making.
Co-occurring mental health conditions are also common. However, with proper diagnosis, treatment, and support, adults with ADHD can develop coping strategies and lead successful lives.
Treatment options include medication, therapy, and coaching to manage symptoms and develop essential skills.
Impact of ADHD signs
Below are some of the consequences that relate to the signs of ADHD. While these are not official signs of ADHD in themselves, they can be viewed as an extension of the signs as they can be commonly experienced.
Emotional difficulties
Emotional dysregulation, which affects an estimated 30-70% of adults and 25-45% of children with ADHD, is characterized by more frequent and intense emotional reactions compared to others.
Common signs include emotional sensitivity, difficulty self-regulating primary emotional responses, trouble self-soothing, challenges in organizing appropriate secondary emotions, and problems refocusing attention away from strong emotions.
Some individuals may also exhibit emotional detachment as a coping mechanism.
These difficulties in regulating emotions can lead to impulsive reactions, mood swings, and impaired daily functioning.
While not everyone with ADHD experiences significant emotional dysregulation, it is considered an important component of the disorder that can have far-reaching effects on well-being and relationships.
Feeling overwhelmed
Feeling overwhelmed can be a sign of ADHD due to overstimulation, which occurs when a person is overwhelmed by environmental, cognitive, or emotional stimuli.
Common signs of ADHD overstimulation include sensory and emotional sensitivity, anxiety, restlessness, impulsivity, emotional outbursts, cognitive overload, fatigue, and information-processing challenges.
People with ADHD may feel extreme discomfort, panic, physical and mental exhaustion, headaches, and energy fluctuations when overstimulated.
Oversensitivity to stimuli, executive dysfunction, emotional dysregulation, and task complexity can all contribute to feelings of overwhelm.
In severe cases, overstimulation may lead to meltdowns (intense emotional outbursts) or shutdowns (disengagement and withdrawal).
Procrastination
Procrastination can be a sign of ADHD, with up to 95% of adults with ADHD struggling to complete tasks on time.
This chronic procrastination likely stems from underlying deficits in executive functioning skills such as organization, prioritization, working memory, and impulse control.
Difficulties regulating negative emotions also contribute to procrastination, as adults with ADHD tend to delay responsible tasks in favor of more instantly gratifying activities.
The combination of executive dysfunction, emotional dysregulation, and impulsivity creates a procrastination cycle that can significantly impair occupational, academic, financial, and interpersonal functioning.
Low self-esteem
Low self-esteem can be a sign of ADHD, manifesting as feelings of shame, low confidence, self-criticism, inadequacy, identity issues, difficulty saying no, and a tendency to withdraw and isolate.
These feelings often stem from the challenges associated with ADHD, such as emotional dysregulation, impulsivity, social interaction struggles, and academic or work difficulties.
The constant struggle to meet societal expectations and personal standards can lead individuals with ADHD to internalize negative perceptions and view themselves as inadequate or unworthy.
ADHD stigma and lack of understanding from others can further contribute to low self-esteem.
Imposter syndrome
Imposter syndrome can be a sign of ADHD, as individuals with ADHD often feel the need to overcompensate for their symptoms in a predominantly neurotypical world.
Signs of imposter syndrome in ADHD include pressuring oneself to overperform, engaging in people-pleasing behaviors, minimizing accomplishments, being suspicious of compliments, making comparisons to others, and feeling like a failure despite evidence of success.
The pressure to mask ADHD symptoms and appear capable to others can contribute to imposter syndrome, as individuals fear their true selves will be exposed.
While imposter syndrome may drive some individuals with ADHD to excel, it can also lead to negative outcomes such as anxiety, depression, and low self-esteem.
References
Bolden, J., & Fillauer, J. P. (2020). “Tomorrow is the busiest day of the week”: Executive functions mediate the relation between procrastination and attention problems. Journal of American College Health, 68(8), 854-863. https://doi.org/10.1080/07448481.2019.1626399
Lai, M. C., Lin, H. Y., & Ameis, S. H. (2022). Towards equitable diagnoses for autism and attention-deficit/hyperactivity disorder across sexes and genders. Current Opinion in Psychiatry, 35(2), 90-100.
Mohammadi, M. R., Zarafshan, H., Khaleghi, A., Ahmadi, N., Hooshyari, Z., Mostafavi, S. A., Ahmadi, A., Alavi, S., Shakiba, A. & Salmanian, M. (2021). Prevalence of ADHD and its comorbidities in a population-based sample. Journal of attention disorders, 25(8), 1058-1067. https://doi.org/10.1177/1087054719886372
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293. https://doi.org/10.1176/appi.ajp.2013.13070966
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of global health, 11.
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/
