There are three primary subtypes of ADHD. Primarily inattentive type, primarily hyperactive/impulsive type and combined type, with a number of co-existing disorders.
ADHD primarily inattentive type
Fails to give close attention to details or makes careless mistakes.
Has difficulty sustaining attention.
Does not appear to listen.
Struggles to follow through on instructions.
Has difficulty with organisation.
Avoids or dislikes tasks requiring sustained mental effort.
Is easily distracted.
Is forgetful in daily activities.
Clinically they present as the classical dreamers, disorganised and often living in their own little world. This leads to major problems with planning and task completion.
ADHD primarily hyperactive/impulsive type
Fidgets with hands or feet or squirms in chair.
Has difficulty remaining seated.
Runs about or climbs excessively.
Difficulty engaging in activities quietly.
Acts as if driven by a motor.
Talks excessively.
Blurts out answers before questions have been completed.
Difficulty waiting or taking turns.
Interrupts or intrudes upon others.
The classical hyperactive group are often a danger to themselves because of the impulsive behaviour.
ADHD combined type
The individual meets both sets of inattention and hyperactive/impulsive criteria, constantly fidgeting and busy with something other than what it expected of them at that moment.
Coexisting disorders
In studies as many as 60 percent of individuals with ADHD present with at least one other major disorder. The most common of these coexisting disorders are briefly described below.
Disruptive Behaviour Disorders
Oppositional-Defiant Disorder (ODD) and Conduct Disorder (CD): ODD involves a pattern of arguing with multiple adults, losing one's temper, refusing to follow rules, blaming others, deliberately annoying others, and being angry, resentful.
CD is associated with efforts to break rules without getting caught. Such children may be aggressive to people or animals, destroy property, lie or steal things from others, run away, be truant from school, or break curfews. CD is often described as delinquency.
Mood Disorders
Depression
ADHD is often associated with depression, which usually appears after ADHD has developed. Depression is characterised by sadness (a child may cry frequently, and for no apparent reason), social withdrawal, loss of appetite, self recrimination, insomnia or excessive sleeping, and a loss of interest in activities that were previously enjoyed.
Mania/Bipolar Disorder
Bipolar Disorder may present with symptoms of ADHD in the pre-pubertal child. A family history of bipolar disorder is an important indicator. This disorder takes the form of periods of abnormally elevated mood (mania) alternating with episodes of depression. In children, the manic phase can manifest as pervasive irritability and unprovoked aggression.
The manic phase in adults is usually characterised by an expansive mood, such that the person feels euphoric and extremely confident. The manic individual may go for days without sleeping, tends to speak rapidly and incessantly, and is inclined to behave inappropriately in social settings (having lost their normal inhibitions). During a manic phase people often develop an unrealistic belief in their capabilities, as a result of which they engage in activities or projects which are doomed to failure and which often lead them into financial or other difficulties.
Anxiety
Approximately one third of children with ADHD will also have an anxiety disorder. People with anxiety disorders often worry excessively about a number of things and may feel edgy, stressed out or tired, tense, and have trouble getting restful sleep. A small number of patients may report brief episodes of severe anxiety (panic attacks) with complaints of pounding heart, sweating, shaking, choking, difficulty breathing, nausea or stomach pain, dizziness, and fears of going crazy or dying. These episodes may occur for no reason.
Tourette's Disorder
About seven percent of those with ADHD have Tourette's Disorder. This disorder involves movements and vocal tics. Tics are sudden, rapid, recurrent, non-rhythmic, involuntary movements or vocalisations. The diagnosis of ADHD may precede the onset of tics.
Learning Disabilities
Up to 60 percent of individuals with ADHD have some form of learning disability. Learning disabled persons may have a specific problem reading or calculating, but usually have normal IQ. Dyslexia may have a major impact.
Substance Abuse
Recent research suggests that adolescents with ADHD are at increased risk for very early cigarette use, which is likely to be followed by alcohol and drug abuse if their symptoms are not controlled.
When to see your doctor
If you notice that your child is exhibiting some of the symptoms described in this article, if your child's teacher tells you that your child is negatively influenced by his/her concentration problems and is difficult or disruptive at school - then seek a medical and psychological opinion. Emotional and other behavioural issues may stem from the individual's inability to cope and full evaluation may determine whether ADHD is the issue, or part of the problem.
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