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What does ADHD look like in children and adolescents?

The following behaviours are commonly seen in children with ADHD. Assessment of ADHD may be sensible if a large number of these behaviours occur together, every day, over a lengthy period of time and cause significant problems and disadvantage.

ADHD is on a continuum with symptoms ranging from mild to severe. Symptoms of ADHD may not have much impact until a child reaches a certain transition point, such as starting school, moving into high school, or entering the senior school years. At these times there are increased demands and responsibilities at which point the child may reach the limit of their ability to cope. Children who are very bright or who have a lot of support at home might take longer to show signs of difficulty.

Some children and adolescents will display a mostly “inattentive subtype”, others will have a “hyperactive/impulsive subtype”, while many will have a “combined subtype” involving inattentive, hyperactive, and impulsive behaviours.

Inattentive behaviours

  • Does not seem to hear you when you ask them to do something (needing to ask a number of times to get a response)
  • Not following through on what you ask, despite agreeing to do so (e.g., brush teeth, put on shoes, come to the dinner table)
  • Easily distracted from a task by noises or own thoughts (hard to keep attention on the task at hand)
  • Daydreaming in class such that important instructions or teachings are missed
  • Not following safety instructions (e.g., “Stop the scooter at the corner”)
  • Losing important belongings (e.g., school jumpers, library books, lunch boxes, travel passes, school permission notes, phones and chargers)
  • Forgetting to bring homework books home
  • Forgetting to do homework or return homework to school
  • Not looking after important belongings (e.g., homework or school photos crushed in school bag, lids left off glue, not washing out paint brushes, football left outside in the weather)
  • Starting a task but not completing it, often due to getting distracted or bored
  • Messy and disorganised bedroom (e.g., drawers and doors left open, piles of clean and dirty clothing heaped together on the floor, rotting food in old lunchboxes, dirty plates and cups)
  • Leaving doors and windows unlocked if last to leave home (teenagers)
  • Losing track of time and regularly running late / poor sense of time

Hyperactive behaviours

  • Trying to climb out of the pram or car restraint (toddlers)
  • Running off and getting lost in supermarkets or busy places (toddlers)
  • Refusing to hold hands or be restrained in busy places when needed for safety purposes (toddlers), or jumping out of a parked car without checking for traffic
  • Climbing up furniture, trees, fences in an unsafe manner despite being asked not to do so (preschool, primary school)
  • Not remaining seated at the dinner table or in the classroom
  • Constant chatter or talking too loudly and at the wrong times
  • Interrupting other people’s conversations because unable to wait
  • Difficulty getting to bed, staying in bed, or getting to sleep at night
  • Throwing things in the house without thinking (e.g., balls) thereby breaking windows or furniture by accident

Impulsive behaviours

  • Being disruptive in class, perhaps trying to entertain people
  • Starting an activity without thinking through the consequences (e.g., doing a painting on the dinner table without newspaper underneath, starting to bake cupcakes at bedtime, cutting good clothing to alter its appearance)
  • Rushing through activities without doing them properly in order to get them done (e.g., brushing teeth, homework, music practice)
  • Impulsively speaking without realising the comment might be inappropriate
  • Difficulty keeping secrets when asked
  • Difficulty tolerating boredom (opting for stimulating activities)
  • Getting excited about something new then quickly losing interest
  • Difficulty persisting with activities that require commitment and practice unless very interested (e.g., learning an instrument or language, maths practice)
  • Overeating and making poor food choices
  • Smoking or drinking or impulsive sex (in teenage years)
  • Running up bills for excessive phone use or TV/music downloads
  • Careless spending of pocket money or other savings
  • Difficulty resisting the stimulation of social media, internet, TV, and gaming
  • Engaging in risky impulsive activities, typically when revved up in the company of friends (e.g., train-surfing, shopping trolley joy-rides, being pulled on a skate board behind a car, shoplifting minor items)

Emotional responses

Some researchers believe that emotional regulation difficulties such as short-lived anger outbursts are a core feature of ADHD for many people who have this disorder, although these symptoms are not currently included in the diagnostic criteria. In additional to emotion regulation issues, ADHD can make life difficult and thus create secondary emotional problems. Emotional difficulties that are frequently associated with ADHD include:

  • Feeling overwhelmed
  • Low self esteem / negative sense of self
  • Short temper / brief outbursts of rage and anger
  • Bouts of tearfulness or sadness when stress builds up
  • Feeling socially anxious due to regular social mistakes
  • Difficulty tolerating boredom or frustration, or anxiety about one’s ability to complete a task, which in turn can lead to problems with procrastination and avoidance

Oppositional behaviours

Many children and adolescents with ADHD do the wrong thing because they are not paying attention and are in too much of a hurry. They are often apologetic or upset when the behaviour is brought to their attention. However, some children with ADHD can be quite oppositional. This behaviour is not necessarily part of ADHD but may be suggestive of a separate difficulty called Oppositional Defiant Disorder, which can occur in up to 40% of children and adolescents with ADHD.

  • Loses temper, easily annoyed, angry and resentful
  • Refusing to do things when asked by someone in authority
  • Talking back to people in authority
  • Often deliberately annoys people
  • Can be spiteful and vindictive
  • Blames others for his or her own mistakes