Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by difficulty paying attention, excess activity, and acting without full regards to consequences, which are otherwise not expected for the person's age. Some individuals with ADHD also display difficulty regulating emotions or problems with executive function. For a diagnosis, the symptoms should appear before a person is twelve years old, be present for more than six months, and cause problems in at least two settings (such as school, home, or recreational activities). Although a diagnosis of ADHD causes impairment in one or more areas of the person’s functioning, many children, teens and young adults with ADHD can have sustained attention for tasks they find interesting or rewarding (this can manifest at times as hyperfocus). Sometimes when children are referred for psychological therapy services or an evaluation and attentional issues are suspected, it may be such that subclinical features of ADHD are manifested. That is, although a diagnosis of ADHD is not warranted, minimal features of attentional and/or executive functioning deficits/discrepancies require attention, support, and accommodations (at least in school). ADHD, like many other neurodevelopmental diagnoses, presents as a “spectrum” meaning that various people demonstrate mild, moderate, or severe symptoms – each requiring a somewhat different set of recommendations for the person’s needs to be met. 

The main signs and symptoms of ADHD include inattention, hyperactivity and impulsivity. That is, ADHD can create difficulty in paying close attention to details; people have trouble holding their attention to tasks and trouble organizing tasks and activities. Children, teens, and young adults may lose things necessary for tasks or appear forgetful in daily activities. Because of the shorter attention span, there is a tendency to be more easily distracted. A person with ADHD will likely experience difficulty with structured schoolwork and with completing tasks that are tedious or time-consuming. People may exhibit hyperactive symptoms, but this is not always the case as there are people diagnosed with Attention Deficit Disorder (not with hyperactive features). When hyperactivity is a part of the diagnosis a person may be unable to sit still, he/she fidgets (touching or playing with anything/everything in sight), squirms in their seat, and may leave their seat in inappropriate situations. They feel "driven by a motor" or like their “engine is going too fast.” Sometimes they may talk excessively or more than others. Impulsive symptoms may sometimes be present as well such that people take risks with little thought for the danger. Impulsivity may also present as a tendency to call out answers to questions or often to answer too quickly. People with impulsive features have trouble waiting their turn and interrupt or intrude on conversations.

Other aspects of ADHD that are part of the diagnostic criteria include that the person can become bored with a task after only a few minutes, unless he/she is doing something they find enjoyable. They may appear as if they are not listening when spoken to or they seem to daydream, and become easily confused. The latter is the reason why language functions also need to be assessed when determining a diagnosis of ADHD. For people with ADHD there is also a tendency for processing speed to be hampered and they may take longer to complete tasks (difficulty processing information as quickly and accurately as others). The presentation of ADHD may include that a person has trouble understanding details (or overlook details). They may blurt out inappropriate comments or show their emotions without restraint not realizing the impact it has on others. The research shows that girls with ADHD tend to display fewer hyperactivity and impulsivity symptoms, but more symptoms pertaining to inattention and distractibility

In a comprehensive evaluation for ADHD, it is important to assess associated disorders. For instance, people with ADHD may have learning disabilities or learning disparities because their processing speed and/or working memory is a relative weakness. They may also exhibit emotional regulation problems that impact social relatedness and their general behavior. Anxiety and Mood Disorders have also been found to occur more when people are diagnosed with ADHD. Children with Autism Spectrum Disorder also exhibit many executive functioning challenges that are associated with ADHD. Stereotypic movement disorders and tics are also prevalent with ADHD diagnoses.

The symptoms of ADHD arise from a deficiency in certain executive functions (e.g., attentional control, inhibitory control, and working memory). Executive functions are a set of cognitive processes that are required to successfully select and monitor behaviors that facilitate the attainment of one's chosen goals. The executive function impairments that occur in individuals with ADHD result in problems with staying organized, time keeping, excessive procrastination, maintaining concentration, paying attention, ignoring distractions, regulating emotions, and remembering details. For more information on the topic of executive functioning, please refer to that section on the website.