If you were to ask a random person what they see when they picture a person with ADHD, they would probably describe a troublemaker, likely a child, who can't sit still or gets fidgety at the dinner table.
And while these hyperactivity symptoms indeed fall under one category of ADHD, what many people may not know is that it isn’t the status quo. ADHD takes on different forms – three, to be exact – and looks much different for a woman in her thirties than it would for the child we mentioned in the first example.
What Is ADHD and How Does It Manifest?
ADHD stands for attention deficit hyperactivity disorder, a neuro-behavioral disorder characterized by an ongoing pattern of inattention and/or hyperactivity/impulsivity.
It affects 11% of school-age children in the US and, in more than three-quarters of these cases, symptoms continue into adulthood.
While hyperactivity is the most commonly observed symptom at younger ages, as a person gets older and life's demands increase, inattentiveness and problems with organization and executive function (skills pertaining to self-regulation, planning, and focus) also begin to arise.
So, for example, what appears as fidgety behavior, daydreaming, and careless mistakes in childhood may become inner restlessness, failure to plan ahead, incomplete projects, and forgetfulness in adulthood.
However, ADHD symptoms are not the same for every person and can vary by type. Currently, the DSM-5 divides ADHD into three types:
1. Hyperactive/Impulsive Type
People with hyperactive/impulsive type ADHD feel the need for constant movement. They often fidget, squirm, and struggle to stay seated.
This type of ADHD is more recognizable and more often diagnosed in children and men.
A physician might diagnose an individual with hyperactive/impulsive type ADHD if they fit six of the nine descriptions below:
Being unable to sit still, especially in calm or quiet surroundings.
Fidgeting with or tapping hands or feet or squirming in their seat. For example, a child may fall out of their chair more often than peers, or feel the need to pick up everything and play with it. And an adult may be shifting in their chair or fidgeting with papers during work meetings.
Running or climbing in situations where it is inappropriate. In adolescents or adults, this symptom may manifest as feeling restless.
Being unable to play or engage in leisure activities quietly.
Being “on the go” or acting as if “driven by a motor”. For example, a child might walk away from their desk in the middle of a lesson or when seated at a restaurant, or an adult might leave their office before they are supposed to.
Being overly talkative.
Blurting out an answer before a question has been completed and completing people's sentences.
Having difficulty waiting for your turn. For example, while waiting in line or while engaging in conversations.
Interrupting or intruding on others. For example, a child may start using other children's things without asking or receiving permission. And adolescents and adults may intrude into or take over what others are doing.
In his book Taking Charge of Adult ADHD, Dr. Russell Barkley states that one of the things we’re beginning to understand well about ADHD is that hyperactivity is seen more in kids with the disorder, but then it usually declines substantially by adolescence and adulthood.
Often the only thing that’s left of hyperactivity in adults with ADHD is that feeling of restlessness and the need to keep busy.
2. Inattentive Type
People with inattentive type ADHD have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities. They often have a weak working memory (a type of memory responsible for temporarily storing and manipulating information), and they are easily distracted.
This type of ADHD is more commonly diagnosed in adults and was formerly known as ADD.
Some of the symptoms of inattentive type ADHD include:
Lacking attention to detail and making careless mistakes. For example, a child with inattentive type may rush through a quiz, missing questions they know the answers to, and an adult may fail to carefully read an email at work.
Having problems staying focused on tasks or activities.
Having trouble listening during conversations, even one-on-one. They may feel absent-minded, even in the absence of any obvious distraction.
Having difficulty following through on instructions and failing to finish schoolwork, chores, or duties in the workplace.
Having difficulty organizing tasks and work. For example, they may struggle to manage sequential tasks, keep materials and belongings in order, manage time, and meet deadlines.
Avoiding tasks that require sustained mental effort.
Frequently losing personal belongings.
Becoming easily distracted by their surroundings. For older adolescents and adults, this symptom may include being distracted by irrelevant thoughts.
Forgetting daily tasks. For example, they often forget to run errands, return calls, or pay the bills.
3. Combined Type
A physician will probably diagnose someone with combined type ADHD if they meet the symptoms mentioned in hyperactive type and inattentive type. In other words, if they exhibit six of the nine symptoms listed for each of those two types.
But having combined type ADHD does not automatically mean their ADHD is more severe compared to someone who is diagnosed with hyperactive type or inattentive type. Rather, it means their symptoms are more likely to be evenly distributed between the two types.
Gender Differences in Experiencing ADHD Symptoms
Signs of ADHD are not only different in adults versus children; women and girls with ADHD also have different experiences than boys and men with the same condition.
The reason for this is a combination of factors, such as diagnostic criteria that are based on observations of men and a lack of understanding of symptoms in women.
For example, adolescent girls with ADHD have been found to have more psychological distress than adolescent boys with ADHD. When compared to boys, girls with ADHD reported more anxiety, more distress, more depressive symptoms, and feeling that they had no control over what is going on in their lives.
Because of these symptoms, girls with ADHD may be diagnosed correctly or incorrectly as depressed, and their ADHD may be overlooked. And while their depressive symptoms may initially respond to appropriate medications and therapy, these girls continue to struggle if their ADHD symptoms are not diagnosed and treated as well.
In general, women and girls with ADHD tend to have more problems with inattention than hyperactivity. And this inattention may appear as daydreaming, difficulty processing information or following directions, or being distracted, “spacey”, or “in their own world”.
Even when a woman is hyperactive, her behaviors may often look very different than they do in a man. For example, a woman with ADHD may be hyper talkative or hyperreactive, which are behaviors that are not typically associated with ADHD.
If you think you have ADHD, it’s important to get professional help and to make sure your symptoms aren’t being caused by a condition other than ADHD that requires attention, or a combination of ADHD and another condition.
Most importantly, having a diagnosis of ADHD gives you access to:
A treatment plan that will help you concentrate, persevere, manage your time, and resist distractions that pull you away from what you want and need to do.
Strategies for playing up your strengths.
Tools that can help you compensate for weaknesses.
Coping skills that will boost your success in specific areas, from work to home.
There are three types of ADHD: hyperactive/impulsive type, inattentive type, and combined type. Only a physician can determine which type a person’s symptoms belong to, and suggest a treatment plan that will help them cope.
Once someone has been properly diagnosed, they will begin to understand the reasons behind specific behaviors and will have access to strategies that will help them manage their symptoms and improve their well-being.
And though they may experience challenging days every once in a while, at least they’ll know the reason behind these challenges and have access to the tools to help them keep their ADHD in check. It will also give them more patience and understanding when it comes to how they feel about themselves and stop them from judging themselves harshly if they missed a minor detail or misplaced an item. And that newfound compassion for themselves will go a very long way.
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