Patient Age and ADHD

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ADHD may be a chronic disorder, and it is important to recognize that the symptoms of ADHD may present differently in patients over time, as described here and in the accompanying table.1-2 Refer also to the full DSM 5 diagnostic criteria.

Inattention

The Predominantly Inattentive presentation of ADHD may not come to clinical attention until late childhood, when more sustained attention in school is required. This does not necessarily mean that the symptoms were not present earlier. These symptoms can be hard to detect if there are not also problems with behavior, and they do not always become apparent until the amount or difficulty of work, or the demand to work independently, increases.1,3

Hyperactivity/Impulsivity

Although hyperactivity can remain a consistent symptom of ADHD as a patient ages, the way symptoms manifest may vary with the individual's age and developmental level.1-3

ADHD in childhood

  • Preschool- and school-age children may have difficulty remaining seated or squirm in their seats.

ADHD in late childhood/early adolescence

  • As children mature, overt behavioral symptoms usually become less conspicuous. Signs of excessive gross motor activity may be less common.
  • Hyperactivity may be confined to fidgetiness or an inner feeling of jitteriness or restlessness.

ADHD in late adolescence/adulthood

  • In most individuals, motor hyperactivity attenuates, although a subgroup of individuals experiences the full complement of ADHD symptoms into mid-adulthood.
  • Symptoms of hyperactivity can often take the form of feelings of restlessness and difficulty engaging in quiet, sedentary activities.

Possible Presentation of ADHD Symptoms Over Time2

Children (6-12 Years)

  • Easily distracted
  • Has trouble organizing homework; homework contains careless mistakes and often is not completed
  • Blurts out answers in class before the question is completed
  • Interrupts conversations or intrudes on others
  • Fails to complete chores at home
  • Has difficulty awaiting turn in games
  • Has trouble staying seated

Teenagers (13-17 Years)

  • Displays inner restlessness
  • Has trouble organizing schoolwork; shows poor follow-through
  • Hyperactivity may become less visible

Adult

  • Inattention/concentration problems
  • Has trouble with organization and does not plan ahead
  • Avoids tasks requiring sustained mental effort; has difficulty initiating and completing projects
  • Often unable to follow through on tasks; shifts activities prematurely
  • Misjudges available time
  • Forgetful; often loses things
  • Makes impulsive decisions

Having some of these symptoms of ADHD does not necessarily mean a patient has ADHD.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5®). Arlington, VA: American Psychiatric Publishing; 2013.
  2. Wilens TE, Dodson W. A clinical perspective of attention-deficit/hyperactivity disorder into adulthood. J Clin Psychiatry. 2004;65(10):1301-1313.
  3. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011:128(5):1007-1022, SI1-SI21.