Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulty sustaining attention, elevated activity levels, and impulsivity that is inconsistent with what would be expected for a person's age. Some individuals also experience challenges with emotional regulation and executive functioning. To meet diagnostic criteria, symptoms must appear before age twelve, persist for more than six months, and cause difficulties in at least two settings, such as school, home, or recreational activities.

It is worth noting that many children, teens, and young adults with ADHD can sustain strong focus on tasks they find interesting or rewarding, sometimes to the point of hyperfocus. In other cases, a person may present with subclinical features, meaning that while a full ADHD diagnosis is not warranted, meaningful attentional or executive functioning differences are still present and deserve support and accommodations. Like many neurodevelopmental conditions, ADHD exists on a spectrum, with symptoms ranging from mild to severe, and recommendations are tailored accordingly.

Signs and Symptoms

ADHD presents across three primary areas:

Inattention may look like difficulty focusing on details, trouble sustaining attention through tasks, losing track of materials, appearing forgetful, or seeming easily distracted or prone to daydreaming. Structured schoolwork and lengthy or repetitive tasks tend to be especially challenging. Language processing also plays a role, which is why language functions are assessed as part of a comprehensive ADHD evaluation. Processing speed can also be affected, with some individuals taking longer to complete tasks or work through information accurately.

Hyperactivity, when present, may appear as an inability to sit still, frequent fidgeting or squirming, leaving one's seat at inappropriate times, or a sense of being constantly "on the go." Some individuals talk excessively or have difficulty engaging in quiet activities. It is important to note that not everyone with ADHD experiences hyperactivity. Those diagnosed without hyperactive features are sometimes referred to as having Attention Deficit Disorder (ADD).

Impulsivity can manifest as taking risks without fully considering consequences, blurting out answers, difficulty waiting one's turn, or interrupting and intruding on others' conversations. Some individuals may also express emotions without restraint, not fully recognizing the impact on those around them.

Research consistently shows that girls with ADHD tend to display fewer hyperactive and impulsive symptoms and more symptoms related to inattention and distractibility, which can sometimes lead to under identification.

Associated Conditions

A thorough evaluation for ADHD always considers the possibility of co-occurring conditions. Learning disabilities or learning disparities are common, particularly when processing speed or working memory are relative weaknesses. Anxiety and mood disorders are also frequently seen alongside ADHD, as are emotional regulation difficulties that can affect social relationships and behavior. People with Autism Spectrum Disorder often share many of the executive functioning challenges associated with ADHD, and tic disorders and stereotypic movement disorders are also more prevalent in this population.

The Role of Executive Functioning

Many of the core challenges of ADHD stem from differences in executive functioning, the set of cognitive processes that help us plan, prioritize, stay organized, and manage our behavior in service of our goals. For individuals with ADHD, weaknesses in attentional control, inhibitory control, and working memory can create real difficulties with time management, organization, concentration, filtering distractions, emotional regulation, and remembering important details. For a deeper look at this topic, please visit the Executive Functioning section of this website.