Signs of ADHD in Young People

Attention-deficit/hyperactivity disorder (ADHD) in young people is often misunderstood for several reasons, including lack of knowledge, misconceptions or limited awareness. Many people still misunderstand ADHD as a behavioural issue or a result of poor parenting, rather than recognizing it as a neurological condition. There may be limited understanding of ADHD symptoms, diagnostic criteria, and treatment options among parents, teachers, and sometimes even healthcare providers. Some people think that symptoms of ADHD are just typical childhood behaviours. While all children are occasionally inattentive or hyperactive, the frequency and impact of these behaviours in children with ADHD are more severe and persistent.

The ADHD journey usually starts with the “eureka!” moment, when you realise that your child’s difficulties may stem from ADHD as a biologically based condition rather than “laziness” or being “oppositional”. For some parents, this moment happens when a teacher suggests a different explanation for their child’s behaviour in class or struggling academically. For others, it happens after they learn about ADHD from an article, a TV show, or another parent whose child has the condition.

ADHD can manifest in various ways, not just the stereotypical hyperactivity. For instance, some children might be primarily inattentive and not hyperactive at all. ADHD can manifest in various ways, not just the stereotypical hyperactivity. For instance, some children might be primarily inattentive and not hyperactive at all. ADHD often presents differently in girls, who may be more inattentive and less hyperactive than boys. This can lead to underdiagnosis or misdiagnosis.

A young person may be diagnosed with ADHD if he or she shows some of the symptoms below in two or more settings — for example, at home and at school. Also, the symptoms must affect the child’s functioning or development, and at least some of the symptoms must have been present before age twelve. 

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Symptoms of ADHD – Primarily Inattentive Type (Formerly Known as ADD) 

• Often does not pay close attention to details or makes careless errors in schoolwork, at work, or during other activities (e.g., ignores or misses details, work is not accurate).
• Often has trouble keeping attention on tasks or play activities (e.g., has trouble staying focused during lectures, conversations, or long reading).
• Often does not listen when someone talks to them directly (e.g., mind seems somewhere else, even when there is no obvious distraction).
• Often does not follow instructions and does not finish schoolwork, chores, or duties in the workplace (e.g., begins tasks but quickly loses focus and is easily sidetracked).
• Often has trouble organising tasks and activities (e.g., trouble managing sequential tasks; trouble keeping materials and belongings in order; messy, disorganised work; has poor time management; does not meet deadlines).
• Often avoids, dislikes, or does not want to do tasks that need sustained mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, filling out forms, reviewing long papers).
• Often misplaces things needed for tasks or activities (e.g., school materials, pencils, books, keys, paperwork, glasses).
• Is often distracted by things around them (for older adolescents and young adults, may include unrelated thoughts).
• Is often forgetful in daily activities (e.g., doing chores, running errands)

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Symptoms of ADHD – Primarily Hyperactive-Impulsive Type 

• Often moves hands or feet or squirms in seat.
• Often gets up from seat when staying seated is expected (e.g., gets up from his or her place in the classroom, or in other situations that require staying in place).
• Often runs around or climbs in situations where it is not appropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
• Often cannot play or do leisure activities quietly.
• Is often very active (e.g., cannot be or is uncomfortable being still for long time, as in restaurants; may be seen by others as being restless or hard to keep up with).
• Often talks too much. Often says something before a question is finished (e.g., finishes people’s sentences; cannot wait for turn in conversation).
• Often has trouble waiting for his or her turn (e.g., while waiting in line).
• Often cuts in on others (e.g., interrupts conversations, games, or activities; may start using other people’s things without asking or getting permission)

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ADHD in Younger Children and Toddlers

ADHD is usually not diagnosed in toddlers and preschoolers, unless in more severe cases. This is because hyperactivity and impulsivity, key symptoms of ADHD, are normal for toddlers, which makes it hard to tell if ADHD is there in that age group.

In preschoolers though, the most common ADHD symptom is hyperactivity, according to the National Institute of Mental Health (US) (NIMH). The DSM-5 criteria can be used to better understand if preschool-aged children display ADHD. The following symptoms of hyperactivity, impulsivity, and inattention are common:

• Having trouble paying attention to tasks or play activities.
• Moving around a lot, wiggling, unable to sit still.
• Often not listening when someone talks to them directly.
• Saying things out loud or having trouble waiting for their turn.
• Often not finishing what they start (getting distracted or losing focus).
• Seeming to never stop moving.

These symptoms also apply to children over the age of 5 when thinking about an ADHD diagnosis. For preschoolers, the key is to figure out if your child’s behaviour is expected for their age. It is suggested that parents look for these extra signs of ADHD in pre-school aged children:

• Often fighting with playmates.
• Cannot jump on one foot by age 4.
• Gets bored after doing something for a few moments.
• Has gotten hurt because of running or moving when told not to do so.
• Your child’s ability to follow one or two-step directions without getting sidetracked (i.e., hang up your coat and put away your shoes).
• Your child’s difficulty with “circle/carpet time” and other group activities.
• Whether you have avoided taking your child out in public, even to places that are good for kids, because of how they act.

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ADHD in Teenagers and young adults

The teenage years are tough for both teens and their parents. Even the most well-adjusted teen deals with peer pressure, academic demands, and emotional and physical changes. Teens with ADHD have an extra set of problems: puberty makes their symptoms worse, higher academics stress their executive functions, and a desire for independence sometimes triggers their risky impulsivity just when they’re facing big changes like learning to drive, having sex, trying drugs and alcohol, and making friends with new or different people. For many families, getting through the teen years is a rough ride.

Though symptoms vary depending on ADHD subtype (inattentive, hyperactive/impulsive, or combined) and with other conditions, teens with Attention Deficit Hyperactivity Disorder often have some or all of the following symptoms more than other teens their age:

• Lack of attention and focus.
• Messiness and memory problems.
• Self-centred behaviour.
• Excess energy and restlessness.
• Strong emotions and rejection sensitive dysphoria.
• Impatience and bad choices.
• Poor focus and trouble completing tasks.

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Even though they have chronic problems with these symptoms (listed above), almost everyone with ADHD has a few specific activities or tasks that they can do very well with their executive functions which can make some people confused. This could be in playing a favourite sport or video games; it could be in making art or music or some other hobby. Seeing these exceptions, some parents think that ADHD is just a lack of motivation when in fact ADHD is not a motivation problem. It is a problem with the chemical balance of the brain.

Many of your teens’ troubles at home, at school, and in social settings come from brain differences. ADHD is linked to weak executive skills; the brain-based functions that help teens control behaviour, recognize the need for help, set and achieve goals, balance wants with duties, and learn to function on their own. Executive dysfunction affects the following key skills, important for school and life success:

• Response inhibition (being able to stop an action when situations suddenly change).
• Working memory.
• Emotional control.
• Flexibility.
• Sustained attention.
• Task initiation.
• Planning/prioritizing, organization.
• Time management.
• Goal-directed persistence (staying with a task when it becomes “boring” or hard).
• Metacognition (the awareness and understanding of your own thought processes) 

Check our post on Executive functions

As their bodies grow and change, teens with ADHD tend to fall behind their peers in emotional maturity as well. Experts say a young person with ADHD will not reach the emotional maturity of a neurotypical 21-year-old until they reach their mid or late 30’s due to developmental delays in the brain’s frontal lobes.

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Why is early intervention and diagnosis important

Diagnosing ADHD early allows for immediate educational interventions that can prevent a child from falling behind in school. Special accommodations like extra time on tests can be arranged once a diagnosis is made, helping to level the academic playing field for the child.

Children with untreated ADHD may struggle with forming and maintaining friendships due to impulsivity, inattentiveness, or hyperactivity. Early diagnosis can lead to interventions that improve social skills. Early diagnosis can also help family members understand the condition and adapt their interactions and expectations, which can lead to more harmonious family relationships.

Struggles with academics and social interactions can lead to low self-esteem and psychological treatment can help children develop more positive self-perception. Early intervention can also prevent the development of compensatory negative behaviours like defiance, lying, or aggression, which sometimes develop as coping mechanisms.

 Early treatment often includes training in life skills like organisation and time management, which will serve the individual well into adulthood. ADHD often occurs alongside other conditions like anxiety and depression. Early diagnosis and treatment can reduce the severity or likelihood of these co-occurring conditions.

A formal diagnosis can also open doors to various types of support, from specialised educational services to support groups for families dealing with ADHD.

Overall, early diagnosis allows for timely interventions that can greatly improve the quality of life for children and young people with ADHD and set them on a more positive trajectory for their future.

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Conclusions

Understanding ADHD requires a nuanced, multi-faceted approach that considers medical, psychological, educational, and social factors. Increased education and awareness are key to reducing misunderstandings surrounding this condition.

A coordinated effort involving psychological, educational, and family resources usually provides the most effective management strategy for ADHD in children and young people. Individualised treatment plans are essential since ADHD manifests differently in each individual.