What Are Symptoms and Signs of ADHD in Children?
The symptoms of attention deficit hyperactivity disorder (ADHD) are not physical symptoms such as ear pain or vomiting but rather exaggerated or unusual behaviors. The type and severity of symptoms vary greatly among people with ADHD. The severity of symptoms depends on the degree of abnormality in the brain, the presence of related conditions, and the individual's environment and response to that environment.
The diagnostic criteria for ADHD are outlined in the Diagnostic and Statistical Manual of Mental Health, 5th ed. (DSM-V 2013) by the American Psychiatric Association. All of the symptoms of inattention, hyperactivity, and impulsivity must have persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level of the child.
- Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
- Often has difficulty sustaining attention in tasks or play activities
- Often does not seem to listen when spoken to directly
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
- Often has difficulty organizing tasks and activities
- Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books, or tools)
- Is often easily distracted by extraneous stimuli
- Is often forgetful in daily activities
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in classroom or in other situations in which remaining seated is expected
- Often runs about or climbs excessively in situations in which it is inappropriate
- Often has difficulty playing or engaging in leisure activities quietly
- Often talks excessively
- Often blurts out answers before questions have been completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others (for example, butts into conversations or games)
In addition, some hyperactive, impulsive, or inattention symptoms that cause present difficulties were present before 7 years of age and are present in two or more settings (at school [or work] or at home). There must be clear evidence of significant impairment in social, academic, or occupational functioning, and the symptoms are not entirely caused by another severe physical disorder (for example, severe illness associated with chronic pain) or mental disorder (for example, schizophrenia, other psychotic disorders, severe disabling mood disorders, etc.).
Inattention symptoms are most likely to manifest at about 8 to 9 years of age and commonly are lifelong in duration. The delay in the onset of inattentive symptoms may reflect its more subtle nature (versus hyperactivity) and/or variability in the maturation of cognitive development. Hyperactivity symptoms are usually obvious by 5 years of age and peak in severity between 7-8 years of age. With maturation, these behaviors progressively decline and generally have been "outgrown" by adolescence. Impulsive behaviors are commonly linked to hyperactivity and also peak at about 7-8 years of age; however, unlike their hyperactive counterpart, impulsivity issues remain well into adulthood. Impulsive adolescents are more likely to experiment with high-risk behaviors (drugs, sexual behavior, driving, etc.). Impulsive adults have a higher rate of financial mismanagement (impulse buying, gambling, etc.).
Many children without ADHD may also demonstrate one or more of these behaviors. However, the difference between these children and the child with ADHD is that the behaviors are disruptive, are considered inappropriate for the child's developmental stage, persist for months or years, and occur both at home and at school. A child with ADHD almost never exhibits all of the symptoms, but the symptoms that are present appreciably hinder the child's social, psychological, and/or educational development.
The behaviors of ADHD can mimic mood disorders (for example, bipolar disorder or depression), anxiety, or personality disorder. Those conditions must be ruled out or adequately treated before a definitive diagnosis of ADHD can be made.