What are the typical behaviors and symptoms of Attention Deficit Hyperactivity Disorder (ADHD)?

Behaviors of Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, with symptoms present in multiple settings for at least six months and causing significant impairment. 1

Core Symptoms

Inattentive Symptoms

• Poor attention to detail, making careless mistakes
• Difficulty concentrating or sustaining attention on tasks
• Appears preoccupied, difficulty shifting focus when spoken to directly
• Difficulty completing tasks (gets distracted/sidetracked)
• Organizational challenges (chronic lateness, messiness, disorganized work)
• Reluctance to engage in tasks requiring sustained mental effort
• Difficulty keeping track of belongings/items needed for tasks
• Easily distracted
• Frequently forgetful 1, 2

Hyperactive-Impulsive Symptoms

• Frequent fidgeting (e.g., tapping a desk)
• Difficulty sitting still for prolonged periods
• Feelings of inner restlessness or agitation
• Often loud and disruptive
• Always "on the go," difficult for others to keep up
• Excessive talking
• Frequently interrupts others
• Highly impatient (difficulty waiting in line)
• Often intrudes into others' activities 1, 2

Diagnostic Criteria

To meet DSM-5 criteria for ADHD, there must be:

• An ongoing pattern of symptoms for at least 6 months
• Multiple symptoms (5 or more for adults; 6 or more for children under 17)
• Symptom onset before age 12
• Symptoms present in two or more settings (e.g., home, school, work)
• Evidence that symptoms interfere with or reduce quality of functioning 1, 2

Presentation Types

ADHD is categorized into three presentation types:

1. Predominantly inattentive type: 5+ symptoms of inattention but fewer than 5 symptoms of hyperactivity-impulsivity
2. Predominantly hyperactive-impulsive type: 5+ symptoms of hyperactivity-impulsivity but fewer than 5 symptoms of inattention
3. Combined type: 5+ symptoms of both inattention AND hyperactivity-impulsivity 1

Age-Related Differences in Presentation

Children

• More likely to display obvious hyperactive behaviors
• May have difficulty sitting still in classroom settings
• Often have problems with peer relationships and following rules
• Academic difficulties are common 1

Adolescents

• Hyperactivity often becomes less obvious
• May manifest as inner restlessness or fidgeting
• Inattention and impulsivity often persist
• Increased risk for substance use, mood disorders, anxiety, and risky behaviors
• May have multiple academic difficulties across different subjects 1, 2

Adults

• More likely to present with inattentive symptoms
• Hyperactivity may manifest as inner restlessness rather than overt behavior
• Often experience difficulties with time management, organization, and completing tasks
• May struggle with maintaining employment or relationships
• Challenges managing household responsibilities and parenting 1, 3

Common Functional Impairments

• Academic or occupational underachievement
• Difficulties in social relationships
• Low self-esteem
• Challenges with time management and organization
• Problems completing daily tasks and responsibilities
• Difficulty managing finances
• Challenges with driving safely 2, 4

Common Comorbid Conditions

ADHD frequently co-occurs with:

• Emotional or behavioral disorders (anxiety, depression, oppositional defiant disorder, conduct disorders)
• Developmental conditions (learning disabilities, language disorders, autism spectrum disorders)
• Physical conditions (tics, sleep disorders)
• Substance use disorders 1, 2

Behavioral Differences from Other Conditions

• Unlike depression or anxiety, ADHD symptoms are chronic rather than episodic
• Unlike bipolar disorder, mood issues in ADHD are typically related to frustration and emotional dysregulation rather than euphoria or severe irritability
• Unlike oppositional behavior, ADHD symptoms are not primarily driven by defiance or hostility 1, 2

Important Considerations

• Symptoms must cause significant impairment in functioning
• Symptoms must be developmentally inappropriate
• Symptoms must not be better explained by another mental disorder
• Symptoms often vary in severity depending on the setting and demands of the environment 1, 2

By understanding these behavioral patterns, clinicians can better identify ADHD and distinguish it from other conditions with overlapping symptoms.