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Signs and symptoms[edit | edit source]

ADHD is a chronic condition, beginning in early childhood that can persist throughout a person's lifetime. It is estimated that 33–66% of children with ADHD will continue to have significant ADHD-related symptoms persisting into adulthood, resulting in a significant impact on education, employment, and interpersonal relationships.

Individuals with ADHD appear to exhibit  deficits in fluid intelligence, a psychological process that refers to the ability to reason, to flexibly engage with the world, to recognize patterns, and to solve problems. According to the Cattell-Horn theory on intelligence, fluid intelligence does not depend upon specific previous knowledge or experience. These deficits have been associated with occupational and academic success. Individuals with ADHD also exhibit deficiencies in self-regulation and self-motivation which in turn foster problematic characteristics such as distractibility, procrastination and disorganization. They are often perceived by others as chaotic, with a tendency to need high stimulation to be less distracted and function effectively.

Whereas teachers and caregivers responsible for children are often attuned to the symptoms of ADHD, employers and others who interact with adults are less likely to regard such behaviors as  symptoms. In part, this is because symptoms do change through development; adults who have ADHD are less likely to exhibit obvious or externalized hyperactive behaviors. Instead, they may report constant mental activity and inner restlessness as their hyperactivity internalizes.

Symptoms of ADHD (see table below) can vary widely between individuals and throughout the lifetime of an individual. As the neurobiology of ADHD is becoming increasingly understood, it is becoming evident that difficulties exhibited by individuals with ADHD are due to problems with the parts of the brain responsible for executive functions (see below: Pathophysiology). These result in problems with sustaining attention, planning, organization, prioritization, time blindness, impulse control, cognitive control and decision making. It should be noted that not all individuals with ADHD have these executive function deficits. Some researchers have suggested that a dual-pathway model underpins ADHD (Sonuga-Barke, 2002). The first pathway accounts for the individuals who exhibit executive function deficits. The second pathway may account for individuals who exhibit deficits in their motivational style. Specifically, these individuals are delay averse; they prefer smaller rewards now instead of larger delayed rewards. The first pathway has been shown to be associated with the inattention symptoms of ADHD and the second to the hyperactivity/impulsivity symptoms.

The difficulties generated by these deficiencies can range from moderate to extreme, resulting in the inability to effectively structure their lives, plan daily tasks, or think of and act accordingly even when aware of potential consequences. These lead to poor performance in school and work, followed by underachievement in these areas. In severe cases, these deficits may lead to unemployment and financial problems. In young adults, poor driving record with traffic violations as well as histories of alcoholism or substance abuse may surface. The difficulty is often due to the ADHD person's observed behaviour (e.g. the impulsive types, who may insult their boss for instance, resulting in dismissal), despite genuinely trying to avoid these and knowing that it can get them in trouble. Often, the ADHD person will miss things that an adult of similar age and experience should catch onto or know. These lapses can lead others to label the individuals with ADHD as "lazy" or "stupid" or "inconsiderate”. The excessive talking and intrusion on others associated with the hyperactivity/impulsivity symptoms are often perceived as socially inappropriate by others and this may also lead to relationship problems, whether these relationships are professional, romantic, or platonic.

As problems accumulate, a negativistic self-view becomes established and a vicious circle of failure is set up. Up to 80% of adults may have some form of psychiatric comorbidity such as with mood disorders and anxiety disorders . Many with ADHD also have associated learning disabilities, such as dyslexia, which contributes to their difficulties.

Studies on adults with ADHD have shown that, more often than not, they experience self stigma and depression in childhood, commonly resulting from feeling neglected and different from their peers. These problems may play a role in the high levels of depression, substance abuse, and relationship problems that affect adults with ADHD later in life.  

Diagnosis[edit]

While there is no single medical, physical, or genetic test for ADHD an evaluation can be provided by a qualified mental health care professional or physician who gathers information from multiple sources. These can include ADHD symptom checklists, standardized behavior rating scales, a detailed history of past and current functions including the person's history of childhood behavior and school experiences, and information obtained from family members, friends, or significant others. The evaluations also seek to rule out other conditions or differential diagnoses such as depression, anxiety, or substance abuse. Other diseases such as hyperthyroidism may exhibit symptoms similar to those of ADHD, and it is imperative to rule these out as well. Asperger syndrome, a condition on the autism spectrum, is sometimes mistaken for ADHD, due to impairments in executive functioning found in some people with Asperger syndrome. However, Asperger syndrome also typically involves difficulties in social interaction, restricted and repetitive patterns of behavior and interests, and problems with sensory processing, including hypersensitivity. Along with this, the quality of diagnosing an adult with ADHD can often be skewed being that the majority of adults with ADHD also have other complications, ranging from anxiety and depression to substance abuse.

Assessment of adult patients seeking a possible diagnosis can be better than in children due to the adult's greater ability to provide their own history, input, and insight. However, these self-reports can sometimes be biased and diagnosis can be complicated by comorbid conditions. It has also been noted that many individuals develop coping strategies that reduce ADHD impairments and, therefore, they never seek treatment. .^{[unreliable medical source?]}

Formal tests and assessment instruments such as IQ tests, standardized achievement tests, or neuropsychological tests typically are not helpful for identifying people with ADHD. However, researchers have recently examined computerized tasks such as continuous performance tests (CPT) in order to measure attention and impulsivity in objective ways and complement their evaluations  (Berger, Slobodin, & Cassuto, 2017). Some of these tests appear to properly distinguish between ADHD individuals and unaffected individuals. While these psychological tests are not used alone for diagnosis, they are useful in the evaluation of specific cognitive deficits that may accompany adult ADHD. Furthermore, no currently available physiological or medical measure is definitive diagnostically. However, psycho-educational and medical tests are helpful in ruling in or out other conditions (e.g. learning disabilities) that may be associated with ADHD-like behaviors.

Comorbidity

In childhood, ADHD is often comorbid with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Adult ADHD is often comorbid with other psychological conditions such as mood disorders (like depression or bipolar disorders) and anxiety disorders. It is also often comorbid with substance use problems. ADHD alone has been found to be a risk factor for substance use disorder. This risk increases when ADHD is comorbid with other disorders. The self-medication hypothesis is a potential explanation for this increased risk. This theory suggests that adults with ADHD may be using substances in order to self-medicate and reduce the symptoms associated with their disorders.