What actually IS ADHD? Do I have it if I struggle to stay seated? Do I have it if I can’t remember why I walked into a room? Do I have it if I did really well in school as a child but now I am struggling to juggle my adult responsibilities?
ADHD stands for Attention-Deficit/Hyperactivity Disorder. Is is a neurodevelopmental (based in the brain and how it developed in utero) difference that impacts someone during childhood and, often, into adulthood. It can have an impact on someone's ability to use the "brake and gas pedals in their brain." For some people, they can't hit the breaks and act impulsively. For other people, they struggle to use gas pedal and don't follow through on tasks or complete responsibilities.
Someone with ADHD had difficulties before the age of 12. The difficulties could have occurred in keeping their room clean, sitting still, or waiting their turn. When the original criteria for ADHD was written, psychologists thought symptoms had to show up even earlier than age 12 but they now know this isn’t true. Also, psychologists learned adults are pretty terrible at accurately remembering what life was like before they were 7 years old.1
Symptoms of ADHD can vary for each individual. In fact, there are 116,220 combinations of symptoms within a diagnosis of ADHD.2 Someone with ADHD may look like the stereotypical child with ADHD - can’t sit still in a classroom, climbing on the furniture, and interrupting teachers and parents. But here is a really important update on how we understand ADHD… girls with ADHD don’t always present in the classic way (i.e., the way boys present). Someone can have ADHD without hyperactivity and impulsivity. A girl with ADHD may look like a daydreamer who spends time staring out the window or who doesn’t seem to listen when adults are talking to her. She may create plans for herself and then have trouble following through, showing emotions like sadness or anxiety about her behavior. She may seem forgetful but it can be played off as being “busy,” “flighty,” or “a worrier.”
The title “Attention-Deficit/Hyperactivity Disorder” can be confusing because it is used even when the person doesn’t have symptoms of hyperactivity. When you hear the term “ADD,” someone may be trying to capture the presentation of ADHD without hyperactivity. However, the actual diagnosis is “ADHD” and it is broken into three types.
When a psychologist is determining what type of ADHD someone has, they will ask many questions about symptoms. A symptom is simply an emotion, thought pattern, behavior, interaction pattern with others, or physical sensation. For a diagnosis of ADHD, someone needs to have a particular number of these symptoms. So for example, if an individual struggles to follow through with instructions but doesn’t have any of the other symptoms of inattention, they would not receive a diagnosis of ADHD that includes inattention. Or if someone has trouble sitting still during a boring meeting but does not have other symptoms of hyperactivity, they would not receive a diagnosis of ADHD that includes hyperactivity/impulsivity.
There are 9 symptoms of inattention in ADHD.
There are 9 symptoms of hyperactivity and impulsivity in ADHD.
Once the symptoms of ADHD are determined and the ADHD type (or “presentation”), then the severity is also determined. ADHD can be mild, moderate, or severe. When a diagnosis is made, the severity helps communicate how much the symptoms of the diagnosis impact the individual’s life and how many of the possible symptoms are actually present. For example, if the individual has just enough symptoms for a diagnosis of ADHD and if they are only being impacted in a small way, they may be diagnosed with mild ADHD. However, if someone has pretty much every possible symptom and their college academics or job, relationships, and ability to take care of their own needs (e.g., self-care activities, paying bills, etc.) is highly impacted, they may be diagnosed with severe ADHD.
Difficulties with attention, activity level, and impulsivity rise to the level of an ADHD diagnosis when they are actually impairing someone’s life. Many people experience symptoms of ADHD in their life that do not occur in multiple settings or create difficulties for them. For example, someone might “talk excessively” when they are with a close friend they have not seen in some time. Or someone might have a hard time focusing during a boring lecture when they have something exciting planned for the weekend or when they did not sleep well. However, these occurrences are not consistent, do not change the course of academics, relationships, or jobs, and do not create significant mental of physical health issues. It may be helpful to think of this impairment piece in terms of depth and breadth in the life domains that can be impacted.
If you are an adult wondering if you have ADHD, an assessment may be something to consider. ADHD assessments are completed with a licensed mental health professional who is trained in how to ask the right questions and collect the right information to help you better understand your mental health and if you do or don’t have ADHD.
Not all ADHD assessments are created equal. Some ask way too few questions and some way too many. For example, if someone just reads off the symptoms of ADHD and then says you do or don’t have ADHD, you are not getting a thorough enough assessment. Also, if someone says it is going to take them 10 hours of face to face time with you and they are assessing for things that are not at all relevant to you, you are getting too thorough of an assessment. It is always a good idea to find out what all goes into an assessment and why!
Partnering with a mental health provider who uses science-based (also called evidence-based or standardized) assessment strategies is very important. A good adult ADHD assessment will have these components at a minimum:
OF NOTE: It is important to note that assessment of ADHD often means discussing many of the negatives. Individuals with ADHD have many strengths but the current accepted process of diagnosing ADHD is based on symptoms and impairment. If the mental health person doing the assessment keeps asking questions like “how do your symptoms get in the way of your life” or if they ask you questions that highlight things you don’t love about yourself (e.g., wishing you had more consistent self-care behaviors like brushing your teeth), please remember you are way more than any symptoms or diagnosis.