Contents

1 ADHD symptoms

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience tasks that require sustained mental effort as unpleasant and markedly aversive. Avoidance of these tasks and failure to complete tasks must be due to difficulties with attention, and not a primary oppositional attitude, although secondary oppositionalism is common, and therefore, hard to distinguish. Approximately half of clinic-referred children with ADHD are also diagnosed with Oppositional Defiant Disorder or Conduct Disorder [1]. Individuals diagnosed with ADHD are easily distracted by irrelevant stimuli and more frequently interrupt ongoing tasks to attend to trivial noises or events (i.e. a car alarm outside while in a classroom setting) that are normally ignored by others. When a person with ADHD is in a novel environment, in a one-to-one situation, engaged in interesting activities, or is receiving frequent rewards or remuneration for appropriate behavior, signs and symptoms of the disorder are often minimal or absent [4]. Situations that require sustained attention and mental effort, or lack intrinsic novelty and appeal, typically reveal a worsening of symptoms. Symptoms and features of the disorder vary by developmental stage. As children age into adolescents and adults, previous symptoms of hyperactivity more commonly take the form of feelings of restlessness and difficulty engaging in quiet, sedentary activities [1].

Other associated features of ADHD may include low frustration tolerance, temper outbursts, stubbornness, excessive and frequent insistence that requests be met, mood lability, demoralization, dysphoria, rejection by peers, and poor self-esteem [1]. Academic achievement is often impaired and devalued by the individual with ADHD, leading to conflict with family and school authorities. Variability in individual symptoms often leads family and teachers to believe that the troublesome behavior is willful, often leading to family discord, negative parent/child interactions, and resentment and antagonism in family relationships [1].

Children with ADHD show a great range in intellectual level, as assessed by individual IQ tests, although on average they are slightly below non-ADHD cohorts, also, individuals with ADHD obtain less schooling and have poorer vocational achievement than their peers on average [1].

2 ADHD subtypes

ADHD is currently split into three subtypes: primarily inattentive, primarily hyperactive/impulsive, and a combined subtype. All three subtypes are associated with significant impairment not only in scholastic achievement, but also in familial and social adjustment [1].

2.1 Impulsivity

Impulsivity commonly manifests as impatience, difficulty in delaying responses, difficulty awaiting one’s turn, and frequently interrupting or intruding on others. Peer rejection, and to a lesser extent, accidental injury are more pronounced in the subtypes marked by hyperactivity and impulsivity.

2.2 Inattentive

Individuals with predominantly inattentive subtype have more typical academic deficits and school-related problems, they also tend to be socially passive and appear neglected, rather than rejected by peers [1].

3 ADHD comorbidity with other disorders

Many patients with other disorders, e.g. Tourette’s Disorder, show a high prevalence of ADHD symptoms, although most individuals with ADHD do not have accompanying Tourette’s Disorder [1]. ADHD-like symptoms are also commonly exhibited by patients with established neurogenetic disorders such as Tuberous Sclerosis Complex, Neurofibramatosis I, Turner Syndrome, Williams Syndrome, Velocardiofacial Syndrome, Prader-Willy Syndrome, and Fragile X Syndrome [2]. This suggests that presentation of ADHD symptoms are a common downstream effect of multiple disruptions in biological pathways or neural circuits, though each syndrome arises from different genetic abnormalities with multiple molecular functions [2].

4 ADHD in Adulthood.

ADHD persists into adulthood in about half of children diagnosed with the disorder, is still significantly more prevalent among men than women, and clinician-assessed adult ADHD was significantly higher in non-Hispanic whites, previously married, and people in the ‘other’ employment category (mostly unemployed and disabled) [5], with a total overall prevalence of 3.5 % to 4.5 % of adults [3, 5]. Adults with ADHD were even less likely than ADHD children to have received treatment for ADHD within the past year (< 11% [5]).

ADHD

attention-deficit/hyperactivity disorder

APA

American Psychiatric Association

References