5 ADHD Symptoms Often Overlooked
When you think of ADHD, what comes to mind? You might picture a child who is easily distractable and has trouble retaining information from a teacher’s lesson. Or one who’s unable to sit still fidgets in their seat, or interrupts others.
While it’s true that these behaviors can be a component of ADHD, they’re only a part of the story. ADHD impacts much more than learning and classroom behavior.
These related mood and emotional symptoms can be overlooked yet have a far-reaching impact across the lifespan.
What is ADHD?
Attention-Deficit and Hyperactivity Disorder is a neurodevelopmental condition affecting executive functioning that is strongly inheritable. That means your parent’s genes are a major factor in developing the disorder. A child with ADHD is four times as likely to have a relative diagnosed with the condition. Over one-third of fathers with ADHD have children with the disorder. Complex neurobiological factors interact with the environment to affect the expression of symptoms.
There are three types of ADHD — inattention subtype, hyperactive-impulsive subtype, and combined type. Nine symptoms are related to ADHD inattentive subtype and nine symptoms suggest the hyperactive type. The first indications of ADHD appear in childhood, as early as 3 years old. Based on the diagnostic criteria from the DSM-V, symptoms must be present prior to age 12 across multiple settings (e.g., school, home, and social).
Rating Scales
For parents who are concerned their child may have signs of ADHD, a healthcare professional may use the Vanderbilt Assessment Scale to help make a diagnosis. The Vanderbilt scale is a valid and reliable screening instrument for evaluating ADHD in children, oppositional defiance disorder, academic performance, and other behavioral issues. In adults, an 18-question ADHD Self-Report Scale (ASRS) is a common screening tool.
Rating scales are a valuable resource for evaluating ADHD, but they should be employed together with information gathered from patient interviews. Multiple sources should also be considered. In children, that means both primary caregivers and teachers complete a Vanderbilt Assessment Scale. Behaviors are evaluated through the lens of what is considered age-appropriate in addition to the severity on a scale from mild to severe.
Not Just About Attention
ADHD impacts not only learning and academic performance, but also mood, relationships, and decision-making. Listed below are five lesser-known symptoms to consider.
1) Decreased Frustration Tolerance: Individuals with ADHD on average have lower frustration tolerance, meaning they can become discouraged when facing stressful situations. This is because the disorder impairs the ability to regulate emotions in a controlled way. Small setbacks can result is large bouts of frustration or impatience.
2) Emotional Dysregulation: Without a barrier to set aside uncomfortable emotions, people with ADHD may become more easily overwhelmed with everything in a room. Although not part of the formal diagnostic criteria, emotional reactivity can be a common component of the condition and matches the life experiences of many patients.
3) Rejection Sensitivity: ADHD makes daily life more difficult in school, at work, and at home. When adaptive strategies for coping fall short, this can lead to greater sensitivity to disapproval and criticism. Rejection-sensitive dysphoria is an under-researched symptom of adults with the condition and is related to poor self-perception, negative self-talk, and rumination.
4) Relationship Challenges: Distraction, trouble with organization, and emotional reactivity can strain relationships. Children have more difficulty with social situations. For adults, distraction and inattentiveness can result in real communication challenges or misunderstandings.
5) Risk-Taking Behavior: Individuals with ADHD can be more impulsive, leading to a variety of risk-taking behavior. Children with the condition are at greater risk for driving problems, risky sexual behavior, and alcohol and substance abuse later in life. Psychologist Sharon Saline stated,
Living with ADHD means living with a novelty-seeking brain where only very specific interests foster motivation. On the positive side, this means they are very creative, outside-the-box thinkers.
More than two-thirds of children with ADHD also have a co-existing condition. These include oppositional defiant disorder, anxiety, depression, learning disabilities, tic disorders or motor delays, and insomnia. Comorbidity is the rule rather than the exception. Guidelines recommend that if ADHD presents with other psychiatric conditions in adults, the most impairing disorder should be treated first.
Differences in Gender and Across the Lifespan
ADHD tends to affect males differently than females. Boys are more likely to externalize symptoms, for example running around a classroom or speaking out of turn in school. Females present with more internalizing symptoms that can be harder to catch. This is one reason why boys are diagnosed at a higher rate than girls.
Initially believed to only impact children, we now know that symptoms can persist into adulthood. It’s estimated that 60 to 75% of children with ADHD will still meet the diagnostic criteria as adults. However, hyperactivity may lessen over time as patients develop new coping strategies or are effectively managed on medication.
Although individuals with ADHD may share core diagnostic criteria, researchers are finding significant variability in areas of impairment, development trajectories, and types of concurring conditions. This means that not every person with ADHD will have an identical clinical picture. Research in the future would benefit from categorizing clinically useful profiles of ADHD based on various trajectories across the lifespan and determining if they respond differentially to different treatments.
There’s also ongoing research evaluating underlying neurobiological and genetic causes of the condition. For example, a new study from the NIH successfully identified differences in gene activity in the brains of people with ADHD. The research will help us understand the genetic factors contributing to ADHD and how they overlap with other neurodevelopmental and mood disorders.
