What Does ADHD Look Like?

Attention deficit hyperactivity disorder (ADHD) is a complex disorder having multiple causes including genetics as impacted by one’s environment. The condition is usually diagnosed in childhood, when difficulties arise during play and school, and it is marked by lack of concentration, short attention span, and physical restlessness. ADHD often is blamed on bad parenting, or a “bad” attitude. However, brain-imaging studies have shown that children with this disorder have an underlying neurological dysfunction, which likely accounts for their behavior. In the simplest terms, the brains of these children have yet to come fully “on-line.” It is conjectured that while certain important brain pathways are working normally, cortical regions involved in attention, impulse control, and stimulus integration abilities, have yet to become fully active. ADHD is a widespread affliction that we are just beginning to understand. People with ADHD suffer from overload. That is, they have heightened awareness of incoming stimuli, particularly sight, sound, and touch. They are so bombarded by the normal stimuli in their environment that they cannot filter out the background noise, and they have trouble focusing or concentrating on a problem or a task. Because of their inability to focus, those with ADHD have trouble completing what they start. They have difficulties with making plans and even more difficulty in carrying out plans in an orderly fashion.

People with ADHD tend to be disorganized. Children have messy rooms; adults have cluttered desks; daily activities tend to be chaotic. Attics and basements are likely to be filled with partly completed sewing projects, woodworking projects, repairs, and notebooks; desk drawers are likely to be cluttered with unfinished letters, outlines, and project plans. Many people with the disorder are highly intelligent, but they tend to be underachievers because they cannot concentrate or sustain interest. As a result, family, friends, teachers, and coworkers become impatient and expect them to fail. People with ADHD also have trouble adapting to change. Their life is so full of tumult that even a minor additional change in their routine can be upsetting or can even create a crisis, eg, a parent goes away on a trip, a new teacher takes over a class, the family moves to a new city, or a pet dies.

ADHD afflicted people live under stress so severe they cannot tolerate frustration, and when they are frustrated, they are likely to become angry. The anger tends to come suddenly and explosively, accompanied by slamming doors, harsh words, tantrums, and leaving important meetings in a frenzy. Children get into fights; adults lose jobs and alienate friends. Afterwards, they may be sorry, but the damage is done. With their high level of frustration, people with ADHD are impatient. They hate to wait in line, and delays of any kind can make them frantic. Whatever is going on – a trip, a movie, a class, a discussion – they want it to go quickly and be finished. Their impatience makes people with ADHD impulsive. As children, they leap into action without thinking of consequences. As adults, they drive too fast, use power tools carelessly, and plunge into activities without thinking of the danger. The result is they often hurt themselves or others. People with ADHD have trouble with their orientation to time and space. They may have trouble differentiating their right hand from their left; they may have difficulty following a set of instructions, reading a map, or telling time. As babies or children they constantly are on the move, squirming, twisting, and getting into everything. As adults, they are restless, easily bored, rebellious when asked to follow a routine, and always on the move. It is noteworthy that some of these characteristics are tied to comorbid Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder (DMDD), Bipolar Disorder, and conduct disorder (CD), separate from or existing with ADHD per se.

ADHD symptoms are often more difficult to cope with during the teen years because of the executive functioning that is rapidly developing during the teen years regardless of having ADHD or not. With the addition of juggling extra-curricular activities, homework, due dates, and socializing, one gets a sense of the reasons most teens are frequently tired. In short, even teens with good executive function skills will struggle sometimes. For those who live with ADHD, the difference is that the executive function deficits they experience are evident in childhood well before adolescence and cause significantly more impairment in daily activities, emotional regulation, social skills, and relationships across at least 2 domains. Because it is usually around middle school when the level of homework and expectations become heavier than in the earlier grades, this is the time when it is the easiest to see how weakened executive functions skills can cause obstacles for the individual with ADHD. That said, preteens and teens with ADHD too often are missing the help and assistance they need, perhaps because there is such an ambiguous line between weakened executive function skills in teens without ADHD and teens with ADHD.

While ADHD is often noticeable and diagnosed in childhood or adolescence, it can and does affect individuals well into adulthood.  Symptoms of ADHD can affect couples and the communication and interaction patterns within relationships.  Symptoms of ADHD are often perceived as intentional and can frustrate partners and other family members who feel confused as to why behaviors seem to remain unchanged despite efforts.  Likewise, symptoms of ADHD can also affect friendships and other peer interactions, not just in childhood and adolescence, but also in adulthood.  Many adults with ADHD have struggled with symptoms since childhood but were not diagnosed until adulthood, thereby impacting their frustrations and challenges with the disorder even more. Those with ADHD often find themselves apologizing to people for not returning phone calls, emails, forgetting scheduled events, experiencing disorganization and trouble planning things out. They may miss deadlines at work or have trouble following through on projects or plans. 

Adults with ADHD may also struggle to follow through on familial responsibilities, especially ADHD parents with children who need help getting ready for school and establishing routines on a daily basis.  It can become especially more stressful when both parent and child have ADHD. Many adults who experienced external hyperactivity as a child now experience internal hyperactivity in the form of anxiety, overthinking, ruminating about things throughout the day, or having trouble “shutting their brain down” at night.  More importantly, no matter which stage of life one is in, whether it be childhood or adulthood, many people with ADHD do not feel understood by others and experience a grave sense of failure and desperation as a result of ADHD being seen as a moral defect.

For these reasons, I offer separate services to address these specifically. I provide individual therapy, diagnostic testing and strategies for ADHD, parenting therapy for parents who have ADHD and/or parents with children who have ADHD, couples therapy for one or more adult with ADHD experiencing distress in their relationship with their partner, and I offer family therapy for all members of a family to strengthen their interaction patterns. Additionally, I provide advocacy within the workplace or school settings, assistance with IEP/504 meetings, and professional presentations for additional rates which can be accessed on my Rates page.