Many of us experience bouts of restlessness. Maybe we find ourselves daydreaming during a particularly long work meeting or struggling to complete mundane activities like washing dishes or doing laundry. All these scenarios could be signs of boredom, but what if it’s more than that? What if, like Minnesota freelance writer Pauline Campos, distraction is your normal? From feeling jumpy and irritated to not being able to remain interested enough in a task to stay focused, Campos, 40, says managing the symptoms of attention deficit hyperactivity disorder (ADHD) is a day-to-day struggle. “Some days are productive, and others, I call it a win because I got the bare minimum done.” According to the National Institute of Mental Health, “ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood.” While most people are familiar with the hyperactive aspect of ADHD, many of the more subtle symptoms fly under the radar. Understanding how to identify these overlooked signs of ADHD can help you find an effective treatment. Here’s what you should know.
What exactly is ADHD?
Broadly defined, ADHD is a developmental condition comprised of three main symptoms: inattention, impulsiveness, and hyperactivity (though this last one may or may not accompany the others). CHAAD, the National Resource Center on ADHD, estimates that about 10 million adults have ADHD. The obvious signs of ADHD are symptoms due to deficits in executive functioning, says Ofra Obejas, a licensed clinical social worker and California child and family psychotherapist. “This is the area responsible for planning, prioritizing, organizing, and focus.” While the exact causes aren’t fully understood, researchers believe a combination of factors, including genetics, may play a role. Some studies have suggested that it may be due to an imbalance of neurotransmitters in the brain. ADHD’s symptoms often present in varying levels of severity and, if left untreated in childhood or adulthood, can lead to behavioral, emotional, social, and academic problems. Yet the diagnosis can be tricky, as ADHD symptoms often overlap with those of other physical and psychiatric disorders such as depression, anxiety, and substance abuse. “A person with low self-esteem or anxiety may be suffering from ADHD first and foremost, but instead, the other concern, such as anxiety, is seen as the primary problem, when it’s really just a symptom,” wrote John M. Grohol, PsyD, a Boston clinical psychologist and founder of Psych Central.
How can we identify ADHD in adults?
For Kathryn Goetzke, entrepreneur and chief mood officer at The Mood Factory, hyperactivity doesn’t necessarily equal physical exertion. “It can also mean your brain is running around doing things, which definitely was the case for me,” she says. Goetzke says it took her years to figure out she had ADHD, as she didn’t have classic hyperactivity. “What I did have was impulsivity,” she says. In adults, this symptom can often look like blurting out an answer in a work meeting, wrote Grohol, but it can also manifest as indulgent spending patterns, conversation interruptions, and engagement in risky behaviors. Experts point to several lesser-known symptoms that also can indicate ADHD in adults:
Hyperfocus (or flow) is a less frequently discussed symptom, but one that continues to garner attention from psychologists. “Usually when people think of someone with ADHD, they think of someone super distracted, hyperactive, or spacing out,” says Crystal Lee, PsyD, a licensed psychologist in Los Angeles. But, she says, it’s also true that people with ADHD get hyper-focused on tasks or activities. When your executive functions don’t work as well, Lee explains, it becomes increasingly difficult to leave one task behind and switch to another—resulting in this razor focus. Researcher Brandon Ashinoff, who studies the cognitive and neurological deficits associated with ADHD, defined it as a state of intense concentration where a person loses track of time. “This is weird in the context of ADHD because it’s actually too much attention,” he explained in an interview with the University of Birmingham’s Ideas Lab Predictor Podcast. “You’re focused so intently on something, no other information gets into your brain essentially.”
Difficulty Controlling Emotions
Controlling your emotions requires strong regulatory functioning. Unfortunately, those with ADHD have weaker regulatory functions, which makes it harder for them to do so. This kind of emotional dysregulation, Lee says, can present as an increased aggravation to everyday events. “You might notice that you get frustrated or irritable more quickly or that it’s harder to calm down once you’re upset.”
Bursts of Motivation Based on Interest
People sometimes mistake ADHD as a lack of motivation because people with the condition are great at finishing projects they really enjoy. “This is actually because your brain chemistry is different when you’re engaged in tasks that are rewarding,” says Lee. And it’s this brain chemistry that helps you stay focused and sustains your attention.
Tics and Fidgeting
Many adults outgrow the hyperactivity experienced as children, says Terry Matlen, a licensed clinical social worker from Detroit. But this symptom can still appear in more subtle ways such as leg swinging, pen clicking, skin picking, foot tapping, or lip chewing. In fact, some research has suggested these seemingly nervous tics increase neurotransmitters like dopamine and norepinephrine in the brain, which help with focus and attention (though more research is needed on the subject).
People with ADHD have quite severe negative reactions to criticism or perceived criticism or rejection (known now as Rejection Sensitive Dysphoria). This makes it so a person is more readily hostile or becomes socially withdrawn, resulting in difficulty establishing and maintaining relationships.
While many of us will experience varying degrees of the aforementioned signs throughout our lives, Grohol said we should look at the whole spectrum and ask ourselves: Do my symptoms significantly impact my ability to function in two or more different areas in my life, such as at school and home, or at work and home? “A person with ADHD will struggle with this inattention virtually all the time, in most situations,” Grohol said, “whereas a person who doesn’t have ADHD will be able to focus and pay attention most of the time.”
How can we identify ADHD in children?
One of the defining features of childhood ADHD is hyperactivity. Hyperactivity in children looks as though the child is in constant motion: running, climbing on things, and constantly squirming or fidgeting. This constant motion, Grohol affirmed, is above and beyond normal childhood behavior and, despite the child’s best efforts, does not seem to be within their self-control. As with adults, childhood ADHD could also present as inattention. Inattention comes through most clearly in schoolwork, chores, or projects, and as losing or misplacing things, like an important assignment for school. Children with ADHD might also display impulsive tendencies. In school, for example, they may blurt out an answer before being called on, skip in lines, and fail to wait their turn, among other things. While boys are generally more likely to present with hyperactivity and impulsivity, the difficulty can be diagnosing ADHD altogether, Grohol tells HealthyWay: “The symptoms may appear to be just dismissed as normal ‘boy behavior.’” He emphasizes that girls are more likely to display inattentive symptoms of ADHD compared to boys. For girls, this may look like anxiety, difficulty focusing on tasks or schoolwork, appearing not to listen when spoken to, daydreaming, low self-esteem, and appearing withdrawn. “Some girls with ADHD may also be verbally aggressive toward other children,” Grohol adds, “such as name calling, teasing, or even bullying.” Moreover, according to the American Psychological Association, girls are also at greater risk of developing low self-esteem, underachievement, and problems like depression and anxiety should their symptoms remain untreated. Campos, who found out about her ADHD in her early thirties, expresses a desire to go back in time and receive her diagnosis in childhood. “It’s hard to find out there’s a valid medical reason as an adult for all the internal turmoil you suffered as a kid—feeling different and out of place and not knowing why,” she shares.
What treatment plans are available for children?
While treatment plans for kids typically include medication and psychological intervention, children can also benefit from behavioral treatments such as more structure, specific routines, and clearly stated expectations. According to WebMD, other treatments include social skills training, support groups, and parenting skills training. Obejas offers a two-pronged approach when working with parents. First, she encourages parents to seek education to understand what it’s like to have ADHD. This helps cultivate more empathy when relating to kids who struggle with completing a task. “Then, I teach techniques such as writing task lists and going over them together,” she explains. She also teaches parents and children how to arrange items, helps with prioritizing, and suggests doing the fun tasks before the boring ones.
What treatment plans are available for adults?
After diagnosis, treatment plans for adults include a combination of medicine, therapy, family support, and learning to structure their environment. Receiving cognitive-behavioral therapy by ADHD-trained therapists is also recommended as a way to learn new techniques for managing symptoms. “Always for me, taking a step back, counting to five, and making sure my emotions are in a positive state through deep breathing are keys to staying in positive, healthy, productive relationships.” —Kathryn Goetzke, entrepreneur, diagnosed with ADHD
“Always for me, taking a step back, counting to five, and making sure my emotions are in a positive state through deep breathing are keys to staying in positive, healthy, productive relationships.” —Kathryn Goetzke, entrepreneur, diagnosed with ADHD
Break up large projects into smaller, doable tasks.
Oftentimes, the best approach to working on complex projects is tackling them in smaller steps. For example, if you want to organize clutter in the home, do it by room rather than all at once. Rank each room from easiest to most difficult. Then, schedule a time to work, and divide the rooms into manageable sections. When the easiest room is complete, you can gradually move on to the most difficult. This approach can work for any project.
Act in the moment.
Sometimes, the best course of action is not letting things become overwhelming to begin with. This means staying in the present and acting when necessary. A simple enough example: If you pass an open drawer, close it. When you see a clothing item strewn on the floor, pause and hang it up. The same is true for loose papers or a full wastebasket that needs emptying. Creating these small habits will make things more manageable throughout your day.
Set a timer for 15 minutes and focus on just one thing during that time. Once the timer goes off, you can decide whether to keep going for another slot of 15 minutes or move on to something else. It’s important to be aware of how you are feeling so as not to become overwhelmed—if you find yourself unable to concentrate, try again later that day or the next until the project is finished. The point here is to feel a sense of accomplishment in that set amount of time. The key for living successfully, Goetzke explains, has been setting up her life in a way that feels more manageable. By using strategic resources like calendars and reminders, she doesn’t get as overwhelmed. “Always for me, taking a step back, counting to five, and making sure my emotions are in a positive state through deep breathing are keys to staying in positive, healthy, productive relationships,” she notes. She also uses scents to help ground her in the present moment “and stop my brain from hijacking my actions.”
Create a supportive environment.
Removing judgment and criticism is one of the most important aspects of creating a supportive environment, Obejas affirms. “It’s not that the person with ADHD has a bad attitude or doesn’t care,” she says. “Yelling at someone for failing to do something they are not able to do only creates shame and avoidance.” In fact, some studies have shown that this can cause internalized negativity and self-blame that can end up hampering functioning. To help manage symptoms, Obejas notes, loved ones need to step in and help create an environment that supports the person with ADHD.
The Whole Picture
As with any chronic health condition, a diagnosis of ADHD does not a person make. In other words, it’s important to look at the whole picture. “As hard as it can be sometimes, this is the only way I know how to be, so I’m trying to make the best of it.” —Pauline Campos, freelance writer, ADHD sufferer
“As hard as it can be sometimes, this is the only way I know how to be, so I’m trying to make the best of it.” —Pauline Campos, freelance writer, ADHD sufferer